Provider Demographics
NPI:1184201717
Name:CASTILLO GARCIA, YENISLEY
Entity Type:Individual
Prefix:
First Name:YENISLEY
Middle Name:
Last Name:CASTILLO GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W 74TH PL APT 207
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-5074
Mailing Address - Country:US
Mailing Address - Phone:786-291-7745
Mailing Address - Fax:
Practice Address - Street 1:7265 SW 93RD AVE STE 201
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3656
Practice Address - Country:US
Practice Address - Phone:305-230-4326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-28
Last Update Date:2021-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11011892363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner