Provider Demographics
NPI:1598201105
Name:LOPEZ DEL CASTILLO, ANA (BCABA)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:LOPEZ DEL CASTILLO
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5227 HOLDEN RD
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32927-9004
Mailing Address - Country:US
Mailing Address - Phone:321-514-2259
Mailing Address - Fax:
Practice Address - Street 1:2154 CENTRAL FLORIDA PKWY STE B2
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837
Practice Address - Country:US
Practice Address - Phone:407-674-7670
Practice Address - Fax:407-674-7549
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-06
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-18-9224106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst