Provider Demographics
NPI:1265765184
Name:CASTANEDA, ALFONSO MOISES
Entity type:Individual
Prefix:
First Name:ALFONSO
Middle Name:MOISES
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 1:8772 NW 141ST TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33018-7352
Mailing Address - Country:US
Mailing Address - Phone:786-546-0972
Mailing Address - Fax:
Practice Address - Street 1:911 SW 87TH AVE # 911
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-3206
Practice Address - Country:US
Practice Address - Phone:786-546-0972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy