Provider Demographics
NPI:1285782268
Name:GASTELUM, CHRISTIAN J (MD)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:J
Last Name:GASTELUM
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:PO BOX 51741
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-6041
Mailing Address - Country:US
Mailing Address - Phone:323-307-8900
Mailing Address - Fax:323-881-8864
Practice Address - Street 1:1700 E CESAR E CHAVEZ AVE STE 3300
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2469
Practice Address - Country:US
Practice Address - Phone:323-307-8900
Practice Address - Fax:323-881-8864
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74589207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A745890Medicaid
H74905Medicare UPIN