MEDICARE: ERIC ANTHONY CASTANEDA PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	2129	AZ

General Provider Information

NPI Number	:	1619936002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC ANTHONY CASTANEDA PA-C

Provider Business Mailing Address
First Line	:	3501 E SPEEDWAY BLVD
Second Line	:	# 300
City	:	TUCSON
State	:	AZ
Zip	:	85716-3917
Country	:	US
Telephone Number	:	520-833-5171
Fax Number	:	520-318-7107

Provider Business Practice Location Address
First Line	:	6565 E CARONDELET DR STE 155
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-3587
Country	:	US
Telephone Number	:	520-849-8900
Fax Number	:	520-849-7137

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	11/12/2019

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