Provider Demographics
NPI:1124798251
Name:CASTANEDA, CHRISTIAN (CPHT)
Entity type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:
Last Name:CASTANEDA
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:CHRISTIAN
Other - Middle Name:
Other - Last Name:CASTANEDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11508 CHISOLM TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:SOCORRO
Mailing Address - State:TX
Mailing Address - Zip Code:79927-3429
Mailing Address - Country:US
Mailing Address - Phone:915-208-7947
Mailing Address - Fax:
Practice Address - Street 1:3000 SAUL KLEINFELD DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-0989
Practice Address - Country:US
Practice Address - Phone:915-849-7804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX299131183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician