Provider Demographics
NPI:1649893702
Name:REYES CASTILLO, VICTOR R
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:R
Last Name:REYES 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 1:801 MONTEREY ST STE 202
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2537
Mailing Address - Country:US
Mailing Address - Phone:727-674-8558
Mailing Address - Fax:
Practice Address - Street 1:801 MONTEREY ST STE 202
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2537
Practice Address - Country:US
Practice Address - Phone:727-674-8558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-24
Last Update Date:2020-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker