Provider Demographics
NPI:1790066256
Name:CASTANO, GUSTAVO ALEJANDRO
Entity Type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:ALEJANDRO
Last Name:CASTANO
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 1:1909 GRENACHE LN NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-6770
Mailing Address - Country:US
Mailing Address - Phone:770-757-7771
Mailing Address - Fax:770-916-4506
Practice Address - Street 1:1909 GRENACHE LN NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-6770
Practice Address - Country:US
Practice Address - Phone:770-757-7771
Practice Address - Fax:770-916-4506
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter