Provider Demographics
NPI:1770126815
Name:CASTILLO DIAZ, ZEIDA (MS)
Entity type:Individual
Prefix:
First Name:ZEIDA
Middle Name:
Last Name:CASTILLO DIAZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5757 WATERFORD DISTRICT DR STE 172
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2076
Mailing Address - Country:US
Mailing Address - Phone:786-353-2616
Mailing Address - Fax:786-524-2880
Practice Address - Street 1:5757 WATERFORD DISTRICT DR STE 172
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2076
Practice Address - Country:US
Practice Address - Phone:786-353-2616
Practice Address - Fax:786-524-2880
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-22
Last Update Date:2024-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
FLCBHCMS100987171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker