Provider Demographics
NPI:1598456212
Name:CASTANEDA, AMALIA
Entity type:Individual
Prefix:MS
First Name:AMALIA
Middle Name:
Last Name:CASTANEDA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:CASTANEDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1203
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91386-1203
Mailing Address - Country:US
Mailing Address - Phone:661-644-5696
Mailing Address - Fax:
Practice Address - Street 1:28494 WESTINGHOUSE PL STE 213
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-0934
Practice Address - Country:US
Practice Address - Phone:661-259-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12660101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional