Provider Demographics
NPI:1528252400
Name:CASTANEDA, VIRGINIA ANN
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:ANN
Last Name:CASTANEDA
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 1:3101 DESERT SKY DR
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-8684
Mailing Address - Country:US
Mailing Address - Phone:928-704-2500
Mailing Address - Fax:928-704-2504
Practice Address - Street 1:3101 DESERT SKY DR
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-8684
Practice Address - Country:US
Practice Address - Phone:928-704-2500
Practice Address - Fax:928-704-2504
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3566349171M00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No171M00000XOther Service ProvidersCase Manager/Care Coordinator