Provider Demographics
NPI:1245928886
Name:CASTILLO LANDA, EVERS
Entity type:Individual
Prefix:
First Name:EVERS
Middle Name:
Last Name:CASTILLO LANDA
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 1:305 CHIQUITA BLVD S
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-1426
Mailing Address - Country:US
Mailing Address - Phone:305-316-1834
Mailing Address - Fax:
Practice Address - Street 1:303 NE 3RD AVE STE 6
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-2538
Practice Address - Country:US
Practice Address - Phone:239-789-0041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-270218106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician