Individual
FORTINO CASTANEDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2131 W 3RD ST, FIRST FLOOR, LOS ANGELES, CA 90057
(213) 484-7901
Mailing address
PO BOX 4514, BURBANK, CA 91503-4514
(213) 484-7901
(213) 353-0325
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
A73892
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A738920
BLUE SHIELD
CA
05
—
00A738920
—
CA
01
—
P00273982
RR MEDICARE
CA
Enumeration date
05/16/2006
Last updated
10/23/2007
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