Provider Demographics
NPI:1689741241
Name:CASTANEDA, HAYDEE G (MD)
Entity Type:Individual
Prefix:DR
First Name:HAYDEE
Middle Name:G
Last Name:CASTANEDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 S BURLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-5015
Mailing Address - Country:US
Mailing Address - Phone:562-965-0024
Mailing Address - Fax:
Practice Address - Street 1:2955 E FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-5836
Practice Address - Country:US
Practice Address - Phone:323-585-0732
Practice Address - Fax:323-585-1673
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2015-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA054867208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A548672Medicaid
CA5485728Medicare UPIN
CAG20414Medicare ID - Type UnspecifiedMEDICARE ID NUMBER