Provider Demographics
NPI:1114275872
Name:CASTANEDA, ALEX MARTIN
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:MARTIN
Last Name:CASTANEDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 MALABAR RD SE UNIT 101
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-3124
Mailing Address - Country:US
Mailing Address - Phone:321-733-2966
Mailing Address - Fax:
Practice Address - Street 1:470 MALABAR RD SE UNIT 101
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-3124
Practice Address - Country:US
Practice Address - Phone:321-733-2966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN1485208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice