Provider Demographics
NPI:1407444581
Name:CASTELLANOS, ALEXI ESTEBAN
Entity Type:Individual
Prefix:
First Name:ALEXI
Middle Name:ESTEBAN
Last Name:CASTELLANOS
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 1:691 PO BOX
Mailing Address - Street 2:
Mailing Address - City:LATON
Mailing Address - State:CA
Mailing Address - Zip Code:93242
Mailing Address - Country:US
Mailing Address - Phone:559-922-8020
Mailing Address - Fax:
Practice Address - Street 1:5168 N BLYTHE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-6477
Practice Address - Country:US
Practice Address - Phone:559-255-5900
Practice Address - Fax:559-981-1212
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY2131087106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician