Provider Demographics
NPI:1073527016
Name:CASTANEDA, FLAVIO
Entity Type:Individual
Prefix:DR
First Name:FLAVIO
Middle Name:
Last Name:CASTANEDA
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:FLAVIO
Other - Middle Name:
Other - Last Name:CASTANEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:306 LAKE KARIBA
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-1959
Mailing Address - Country:US
Mailing Address - Phone:956-337-2646
Mailing Address - Fax:956-718-7197
Practice Address - Street 1:2005 E BUSTAMANTE ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5470
Practice Address - Country:US
Practice Address - Phone:956-337-2646
Practice Address - Fax:956-718-7197
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL91292085R0204X, 2085R0202X, 2085B0100X, 2085U0001X, 2085R0205X, 2085R0203X, 2085R0001X, 2085P0229X, 2085N0904X, 2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No2085R0205XAllopathic & Osteopathic PhysiciansRadiologyRadiological Physics
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Y076Medicare UPIN