Provider Demographics
NPI:1124340740
Name:CASTANEDA, ADRIAN (ABOC)
Entity type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:
Last Name:CASTANEDA
Suffix:
Gender:M
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4042 MIHO
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78223-3822
Mailing Address - Country:US
Mailing Address - Phone:210-337-5243
Mailing Address - Fax:
Practice Address - Street 1:4042 MIHO
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-3822
Practice Address - Country:US
Practice Address - Phone:210-337-5243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDR4082156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician