Provider Demographics
NPI:1629793633
Name:CASTRO, FREDDY JOSE
Entity Type:Individual
Prefix:
First Name:FREDDY
Middle Name:JOSE
Last Name:CASTRO
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 1:2000 N CONGRESS AVE LOT 188
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-6346
Mailing Address - Country:US
Mailing Address - Phone:561-475-9294
Mailing Address - Fax:
Practice Address - Street 1:2000 N CONGRESS AVE LOT 188
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6346
Practice Address - Country:US
Practice Address - Phone:561-475-9294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician