Healthcare Provider Details

I. General information

NPI: 1982303269
Provider Name (Legal Business Name): ALEX DE CASTRO-ABEGER, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1636 AVIATION BLVD # 202
REDONDO BEACH CA
90278-2851
US

IV. Provider business mailing address

4832 LINDLEY AVE
ENCINO CA
91316-4232
US

V. Phone/Fax

Practice location:
  • Phone: 310-374-2727
  • Fax: 310-374-3722
Mailing address:
  • Phone: 818-489-4694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALEXANDER HUGO DE CASTRO-ABEGER
Title or Position: PRESIDENT
Credential: MD, MBA
Phone: 818-489-4694