Provider Demographics
NPI:1922861806
Name:KEPPIS CASTILLO, ANEURYS
Entity Type:Individual
Prefix:
First Name:ANEURYS
Middle Name:
Last Name:KEPPIS CASTILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19568 NW 51ST PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-2075
Mailing Address - Country:US
Mailing Address - Phone:786-704-4351
Mailing Address - Fax:
Practice Address - Street 1:19568 NW 51ST PL
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-2075
Practice Address - Country:US
Practice Address - Phone:786-704-4351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-02
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician