Provider Demographics
NPI:1083888614
Name:CASTELLANOS-ALVAREZ, DIANA ZULY (LMT)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:ZULY
Last Name:CASTELLANOS-ALVAREZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6018 SW 18TH ST
Mailing Address - Street 2:SUITE #C10
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-7199
Mailing Address - Country:US
Mailing Address - Phone:561-416-1767
Mailing Address - Fax:
Practice Address - Street 1:6018 SW 18TH ST
Practice Address - Street 2:SUITE #C10
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-7199
Practice Address - Country:US
Practice Address - Phone:561-416-1767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL51770225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist