Provider Demographics
NPI:1851822878
Name:VALDES CASTILLO, IDANIA F
Entity Type:Individual
Prefix:
First Name:IDANIA
Middle Name:F
Last Name:VALDES 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 1:14341 SW 258TH LN APT 2109
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-6766
Mailing Address - Country:US
Mailing Address - Phone:786-803-5640
Mailing Address - Fax:
Practice Address - Street 1:14341 SW 258TH LN APT 2109
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-6766
Practice Address - Country:US
Practice Address - Phone:786-803-5640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-22
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician