Healthcare Provider Details

I. General information

NPI: 1972741502
Provider Name (Legal Business Name): FORTINO CASTANEDA, MD., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 05/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 N RAYMOND AVE UNIT 205
PASADENA CA
91103-4529
US

IV. Provider business mailing address

35 N RAYMOND AVE UNIT 205
PASADENA CA
91103-4529
US

V. Phone/Fax

Practice location:
  • Phone: 626-836-8652
  • Fax: 626-628-1863
Mailing address:
  • Phone: 626-836-8652
  • Fax: 626-628-1863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberA73892
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberA73892
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA73892
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberA73892
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberA73892
License Number StateCA

VIII. Authorized Official

Name: DR. FORTINO CASTANEDA
Title or Position: PRESIDENT
Credential: MD
Phone: 626-437-9516