Provider Demographics
NPI:1811554231
Name:RODRIGUEZ CASTRO, ESTELA D (BCBA, RN)
Entity type:Individual
Prefix:
First Name:ESTELA
Middle Name:D
Last Name:RODRIGUEZ CASTRO
Suffix:
Gender:F
Credentials:BCBA, RN
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Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:1500 COLONIAL BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1025
Mailing Address - Country:US
Mailing Address - Phone:239-294-0901
Mailing Address - Fax:
Practice Address - Street 1:1500 COLONIAL BLVD STE 102
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1025
Practice Address - Country:US
Practice Address - Phone:239-294-0901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X
FL1-20-46098103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103182300Medicaid