Basic Information
| Provider Information | |||||||||
| NPI: | 1568604510 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANTONIO CASTANEDA, MD, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1325 PENNSYLVANIA AVE | ||||||||
| Address2: | SUITE 777 | ||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761042158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8176989700 | ||||||||
| FaxNumber: | 8176989703 | ||||||||
| Practice Location | |||||||||
| Address1: | 1325 PENNSYLVANIA AVE | ||||||||
| Address2: | SUITE 777 | ||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761042158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8176989700 | ||||||||
| FaxNumber: | 8176989703 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2009 | ||||||||
| LastUpdateDate: | 04/06/2009 | ||||||||
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| AuthorizedOfficialLastName: | CASTANEDA | ||||||||
| AuthorizedOfficialFirstName: | CARLA | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8176989700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | K2318 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.