Basic Information
| Provider Information | |||||||||
| NPI: | 1548749633 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASTANEDA | ||||||||
| FirstName: | ANDY | ||||||||
| MiddleName: | BRYAN | ||||||||
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| Credential: | LVN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 EL PASEO ST APT 507 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770543009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9152188378 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2424 WILCREST DR STE 110 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770422772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136668287 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2018 | ||||||||
| LastUpdateDate: | 08/09/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | 332765 | TX | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.