Healthcare Provider Details

I. General information

NPI: 1770498776
Provider Name (Legal Business Name): ALFONSO CASTANEDA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 S ORANGE AVE
ORLANDO FL
32806-1215
US

IV. Provider business mailing address

6147 NW 121ST AVE
CORAL SPRINGS FL
33076-1912
US

V. Phone/Fax

Practice location:
  • Phone: 132-184-1644
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: