Provider Demographics
NPI:1770771511
Name:CASTELLANOS, ALEXANDER F (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:F
Last Name:CASTELLANOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALEJANDRO
Other - Middle Name:F
Other - Last Name:CASTELLANOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:699 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-5103
Mailing Address - Country:US
Mailing Address - Phone:805-434-1804
Mailing Address - Fax:805-434-1855
Practice Address - Street 1:699 S MAIN ST
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-5103
Practice Address - Country:US
Practice Address - Phone:805-434-1804
Practice Address - Fax:805-434-1855
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-05
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37303207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G373030Medicaid
CAG37303Medicare PIN
CA00G373030Medicaid