Healthcare Provider Details

I. General information

NPI: 1669667788
Provider Name (Legal Business Name): EVANGELINA CASTANEDA M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 10/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 W 15TH ST SUITE 118
PLANO TX
75093-5803
US

IV. Provider business mailing address

4100 W 15TH ST SUITE 118
PLANO TX
75093-5803
US

V. Phone/Fax

Practice location:
  • Phone: 972-985-1312
  • Fax: 972-596-7192
Mailing address:
  • Phone: 972-985-1312
  • Fax: 972-596-7192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberG2341
License Number StateTX

VIII. Authorized Official

Name: DR. EVANGELINA CASTANEDADA
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 972-985-1312