Provider Demographics
NPI:1922862119
Name:GUERRERO CASTRO, LEYDI
Entity Type:Individual
Prefix:
First Name:LEYDI
Middle Name:
Last Name:GUERRERO CASTRO
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 1:7510 SW 152ND AVE APT B106
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-2370
Mailing Address - Country:US
Mailing Address - Phone:786-715-5741
Mailing Address - Fax:
Practice Address - Street 1:7510 SW 152ND AVE APT B106
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-2370
Practice Address - Country:US
Practice Address - Phone:786-715-5741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-318444106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician