Provider Demographics
NPI:1689975203
Name:CASTRO, MARIA DE LA CRUZ (SPL)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DE LA CRUZ
Last Name:CASTRO
Suffix:
Gender:F
Credentials:SPL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 NW 117TH ST REAR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33167-3039
Mailing Address - Country:US
Mailing Address - Phone:786-287-5285
Mailing Address - Fax:
Practice Address - Street 1:1830 NW 7TH ST STE 224
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3562
Practice Address - Country:US
Practice Address - Phone:786-953-6302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-12
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL71662355S0801X
FLSZ6564235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant