Provider Demographics
NPI:1295340602
Name:CASTELLANOS, HERCULEZ ALEJANDRO (CADC II)
Entity type:Individual
Prefix:
First Name:HERCULEZ
Middle Name:ALEJANDRO
Last Name:CASTELLANOS
Suffix:
Gender:M
Credentials:CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10442 AVIGNON WAY
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-7870
Mailing Address - Country:US
Mailing Address - Phone:310-482-1430
Mailing Address - Fax:
Practice Address - Street 1:1304 L ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-4509
Practice Address - Country:US
Practice Address - Phone:661-634-9877
Practice Address - Fax:661-864-0198
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA047801117101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)