Provider Demographics
NPI:1134327166
Name:VIDAL CASTANEDA, GERARDO
Entity type:Individual
Prefix:MR
First Name:GERARDO
Middle Name:
Last Name:VIDAL CASTANEDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 SAN JOSE AVE APT B
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4954
Mailing Address - Country:US
Mailing Address - Phone:510-510-8385
Mailing Address - Fax:
Practice Address - Street 1:1909 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1023
Practice Address - Country:US
Practice Address - Phone:510-809-3004
Practice Address - Fax:510-809-3240
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0136Medicaid