Healthcare Provider Details

I. General information

NPI: 1639404577
Provider Name (Legal Business Name): DAISY TAHERE CASTANEDA P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2009
Last Update Date: 04/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 NORTH BLVD
BATON ROUGE LA
70806-3825
US

IV. Provider business mailing address

3801 NORTH BLVD
BATON ROUGE LA
70806-3825
US

V. Phone/Fax

Practice location:
  • Phone: 225-655-6422
  • Fax: 225-341-5745
Mailing address:
  • Phone: 225-655-6422
  • Fax: 225-341-5745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number200262
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: