Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DR4082 | TX |
NPI | 1124340740 |
---|---|
Provider Name | Mr. Adrian Castaneda |
First Address | San Antonio, TX 78223-3822 |
Second Address | San Antonio, TX 78223-3822 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2010 |
Last Update Date | 23/02/2010 |