Provider Demographics
NPI:1649628892
Name:CASTILLO, MARIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name: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 1:2805 W 76TH ST
Mailing Address - Street 2:APTO 202
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-5392
Mailing Address - Country:US
Mailing Address - Phone:786-715-3518
Mailing Address - Fax:
Practice Address - Street 1:2805 W 76TH ST APT 202
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-5392
Practice Address - Country:US
Practice Address - Phone:786-715-3518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-28
Last Update Date:2019-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017564200Medicaid