Provider Demographics
NPI:1306625397
Name:CASTANEDA ISLAS, VALERIA N/A
Entity type:Individual
Prefix:
First Name:VALERIA
Middle Name:N/A
Last Name:CASTANEDA ISLAS
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 1:509 LAKEHURST RD APT GL
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-6671
Mailing Address - Country:US
Mailing Address - Phone:224-391-8193
Mailing Address - Fax:
Practice Address - Street 1:707 LAKE COOK RD STE 312
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4933
Practice Address - Country:US
Practice Address - Phone:877-627-1662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician