Provider Demographics
NPI:1194963207
Name:JUANITO, MA.VICTORIA CASTANEDA (RN)
Entity type:Individual
Prefix:MRS
First Name:MA.VICTORIA
Middle Name:CASTANEDA
Last Name:JUANITO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:MA. VICTORIA
Other - Middle Name:TIONGCO
Other - Last Name:CASTANEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:212 E 77TH ST APT 4C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-2185
Mailing Address - Country:US
Mailing Address - Phone:646-726-4047
Mailing Address - Fax:
Practice Address - Street 1:122 E 23RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4516
Practice Address - Country:US
Practice Address - Phone:212-677-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY578395251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services