Provider Demographics
NPI:1568467363
Name:CASTANEDA, FERNANDO ANGEL (MD)
Entity type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:ANGEL
Last Name:CASTANEDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4151 LOOP 20
Mailing Address - Street 2:STE 102
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-4741
Mailing Address - Country:US
Mailing Address - Phone:956-795-8255
Mailing Address - Fax:956-795-8257
Practice Address - Street 1:4151 JAIME ZAPATA HWY
Practice Address - Street 2:STE 102
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043-4741
Practice Address - Country:US
Practice Address - Phone:956-795-8255
Practice Address - Fax:956-795-8257
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2319208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX102582704Medicaid
0052JEOtherBC BS #
TX102582705Medicaid
0052JEOtherBC BS #