Healthcare Provider Details

I. General information

NPI: 1699574848
Provider Name (Legal Business Name): ANDREA S CUAMATZI CASTELAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA S CASTELAN URIBE

II. Dates (important events)

Enumeration Date: 03/11/2025
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 N ASHLAND AVE FL 1
CHICAGO IL
60622-6355
US

IV. Provider business mailing address

531 N ASHLAND AVE FL 1
CHICAGO IL
60622-6355
US

V. Phone/Fax

Practice location:
  • Phone: 734-277-0815
  • Fax:
Mailing address:
  • Phone: 734-277-0815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: