Provider Demographics
NPI:1689234866
Name:CASTILLO MEDINA, ORLAIDIS
Entity Type:Individual
Prefix:
First Name:ORLAIDIS
Middle Name:
Last Name:CASTILLO MEDINA
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 1:15385 SW 73RD TERRACE CIR APT 7
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-1694
Mailing Address - Country:US
Mailing Address - Phone:786-450-1415
Mailing Address - Fax:
Practice Address - Street 1:15385 SW 73RD TERRACE CIR APT 7
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-1694
Practice Address - Country:US
Practice Address - Phone:786-450-1415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician