Provider Demographics
NPI:1205277431
Name:CASTANEDA, LAURA VERONICA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:VERONICA
Last Name:CASTANEDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 ODESSA AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-1944
Mailing Address - Country:US
Mailing Address - Phone:925-206-9296
Mailing Address - Fax:
Practice Address - Street 1:1413 F ST
Practice Address - Street 2:PORTABLE 1
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-2220
Practice Address - Country:US
Practice Address - Phone:925-777-1133
Practice Address - Fax:925-777-9933
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA791464163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse