1952603920 NPI number — MRS. ANGELA CELINA ALCALA CASTANEDA PT

Table of content: MRS. ANGELA CELINA ALCALA CASTANEDA PT (NPI 1952603920)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952603920 NPI number — MRS. ANGELA CELINA ALCALA CASTANEDA PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASTANEDA
Provider First Name:
ANGELA CELINA
Provider Middle Name:
ALCALA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALCALA
Provider Other First Name:
ANGELA CELINA
Provider Other Middle Name:
BELARMINO
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1952603920
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
329 13TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TELL CITY
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47586-1820
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-230-9716
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
604 RENNAKER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA FONTAINE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46940-9045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-981-2081
Provider Business Practice Location Address Fax Number:
765-981-4954
Provider Enumeration Date:
11/24/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  5009748A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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