Provider Demographics
NPI:1821849175
Name:CASTILLO, LEYDIS LAURA
Entity Type:Individual
Prefix:
First Name:LEYDIS
Middle Name:LAURA
Last Name: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 1:9422 NW 120TH ST APT 230
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4008
Mailing Address - Country:US
Mailing Address - Phone:305-462-5272
Mailing Address - Fax:
Practice Address - Street 1:9422 NW 120TH ST APT 230
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-4008
Practice Address - Country:US
Practice Address - Phone:305-462-5272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-24-336199106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician