Provider Demographics
NPI:1699203869
Name:CASTILLO GARCIA, YISSIAN
Entity Type:Individual
Prefix:
First Name:YISSIAN
Middle Name:
Last Name:CASTILLO GARCIA
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 1:27984 SW 136TH PL
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-7743
Mailing Address - Country:US
Mailing Address - Phone:239-645-6968
Mailing Address - Fax:
Practice Address - Street 1:10200 NW 25TH ST STE 114
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-5919
Practice Address - Country:US
Practice Address - Phone:305-908-2999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-31
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician