Provider Demographics
NPI:1689267486
Name:ORTEGA CASTILLO, SALLY BETZABE
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:BETZABE
Last Name:ORTEGA CASTILLO
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 1:5305 WATERMILL LN APT 304
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-7857
Mailing Address - Country:US
Mailing Address - Phone:786-227-9265
Mailing Address - Fax:
Practice Address - Street 1:1820 ARMSTRONG BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-2589
Practice Address - Country:US
Practice Address - Phone:407-559-4854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician