Provider Demographics
NPI:1770445264
Name:CASTANEDA, MYA
Entity type:Individual
Prefix:
First Name:MYA
Middle Name:
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 1:5601 W SLAUSON AVE STE 168
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6584
Mailing Address - Country:US
Mailing Address - Phone:310-410-4450
Mailing Address - Fax:310-410-4455
Practice Address - Street 1:5601 W SLAUSON AVE STE 168
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6584
Practice Address - Country:US
Practice Address - Phone:310-410-4450
Practice Address - Fax:310-410-4455
Is Sole Proprietor?:No
Enumeration Date:2025-12-02
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician