Provider Demographics
NPI:1982303269
Name:ALEX DE CASTRO-ABEGER, MD
Entity Type:Organization
Organization Name:ALEX DE CASTRO-ABEGER, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:HUGO
Authorized Official - Last Name:DE CASTRO-ABEGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MBA
Authorized Official - Phone:818-489-4694
Mailing Address - Street 1:4832 LINDLEY AVE
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-4232
Mailing Address - Country:US
Mailing Address - Phone:818-489-4694
Mailing Address - Fax:
Practice Address - Street 1:1636 AVIATION BLVD # 202
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-2851
Practice Address - Country:US
Practice Address - Phone:310-374-2727
Practice Address - Fax:310-374-3722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-27
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus SpecialistGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty