Provider Demographics
NPI:1215596739
Name:BALDO CASTELLANOS, ABDEL ABRAHAM
Entity Type:Individual
Prefix:
First Name:ABDEL
Middle Name:ABRAHAM
Last Name:BALDO CASTELLANOS
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 1:7724 SW 36TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3502
Mailing Address - Country:US
Mailing Address - Phone:786-378-3890
Mailing Address - Fax:
Practice Address - Street 1:7724 SW 36TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3502
Practice Address - Country:US
Practice Address - Phone:786-378-3890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-08
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-88502106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician