MEDICARE: ALEXI ESTEBAN CASTELLANOS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	Y2131087	CA

General Provider Information

NPI Number	:	1407444581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXI ESTEBAN CASTELLANOS

Provider Business Mailing Address
First Line	:	691 PO BOX
Second Line	:
City	:	LATON
State	:	CA
Zip	:	93242
Country	:	US
Telephone Number	:	559-922-8020
Fax Number	:

Provider Business Practice Location Address
First Line	:	5168 N BLYTHE AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93722-6477
Country	:	US
Telephone Number	:	559-255-5900
Fax Number	:	559-981-1212

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2021
Last Update Date	:	01/05/2021

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Directions to “ ALEXI ESTEBAN CASTELLANOS ” Practice Location

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