Provider Demographics
NPI:1467121202
Name:CASTANEDA AGUDELO, CATALINA
Entity Type:Individual
Prefix:
First Name:CATALINA
Middle Name:
Last Name:CASTANEDA AGUDELO
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 1:7510 DICKENS AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-2277
Mailing Address - Country:US
Mailing Address - Phone:786-296-1319
Mailing Address - Fax:
Practice Address - Street 1:6760 BULL RUN RD APT 148
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-8108
Practice Address - Country:US
Practice Address - Phone:786-296-1319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-07
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21-182428106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician