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General NPI Number Information
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NPI Number | 1598848525
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Entity Type | Individual
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Provider Name | JENA MAE BAWE CASTANEDA PT
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Gender | Female
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 03/27/2020
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Provider Practice Location Address
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Address Line | 39775 SUNROSE DR
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City | MURRIETA
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State | CA
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Zip | 92562-4126
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Country | US
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Telephone | 951-813-5297
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Fax | 951-677-7309
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Provider Business Mailing Address
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Address Line | 3250 LOMITA BLVD SUITE 306
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City | TORRANCE
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State | CA
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Zip | 90505-5014
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Country | US
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Telephone | 310-539-8800
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Fax | 310-698-5414
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 8228
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT34378
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License Number State | CA
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