Provider Demographics
NPI:1568983278
Name:CASTELLANOS CRUZ, RODELOY
Entity Type:Individual
Prefix:
First Name:RODELOY
Middle Name:
Last Name:CASTELLANOS CRUZ
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 1:10475 SW 216TH ST APT 203
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1631
Mailing Address - Country:US
Mailing Address - Phone:786-370-5072
Mailing Address - Fax:
Practice Address - Street 1:10475 SW 216TH ST APT 203
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33190-1631
Practice Address - Country:US
Practice Address - Phone:786-370-5072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-03
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
18-53232106S00000X
0-19-10578106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician