Provider Demographics
NPI:1700693645
Name:CASTANEDA DELANO, DESAREI S
Entity type:Individual
Prefix:MS
First Name:DESAREI
Middle Name:S
Last Name:CASTANEDA DELANO
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 1:644 MEAKANU LN
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-2945
Mailing Address - Country:US
Mailing Address - Phone:818-554-8601
Mailing Address - Fax:
Practice Address - Street 1:1867 E VINEYARD ST # 2ND
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1847
Practice Address - Country:US
Practice Address - Phone:808-298-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician