Provider Demographics
NPI:1063644102
Name:HAYDEE G CASTANEDA MD INC.
Entity Type:Organization
Organization Name:HAYDEE G CASTANEDA MD INC.
Other - Org Name:WOMEN FAMILY MEDICAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HAYDEE
Authorized Official - Middle Name:G
Authorized Official - Last Name:CASTANEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-634-7431
Mailing Address - Street 1:3331 E ARTESIA BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-2812
Mailing Address - Country:US
Mailing Address - Phone:562-634-7431
Mailing Address - Fax:
Practice Address - Street 1:3331 E ARTESIA BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-2812
Practice Address - Country:US
Practice Address - Phone:562-634-7431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-21
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54867207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA54867OtherLICENSE NUMBER
CA00A548672OtherMEDICAL
CA00A548672Medicare UPIN
CA5485728Medicare UPIN
CAG20414Medicare UPIN