Basic Information
| Provider Information | |||||||||
| NPI: | 1376040709 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CASTANEDA | ||||||||
| FirstName: | GONZALO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1644 259TH ST APT A | ||||||||
| Address2: | |||||||||
| City: | HARBOR CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907103290 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195044046 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1403 LOMITA BLVD FL 2 | ||||||||
| Address2: | |||||||||
| City: | HARBOR CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907102076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105347600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2018 | ||||||||
| LastUpdateDate: | 07/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0505X | A173551 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine |
No ID Information.