Provider Demographics
NPI:1265273338
Name:DELGADO CASTRO, MIRELYS
Entity type:Individual
Prefix:
First Name:MIRELYS
Middle Name:
Last Name:DELGADO 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 1:1160 NW 142ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33168-6850
Mailing Address - Country:US
Mailing Address - Phone:754-779-3747
Mailing Address - Fax:
Practice Address - Street 1:1160 NW 142ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33168-6850
Practice Address - Country:US
Practice Address - Phone:754-779-3747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-128061106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician