Provider Demographics
NPI:1811625791
Name:CASTILLO RODRIGUEZ, DILBERTO
Entity type:Individual
Prefix:
First Name:DILBERTO
Middle Name:
Last Name:CASTILLO RODRIGUEZ
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 1:630 SW 39TH CT
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2008
Mailing Address - Country:US
Mailing Address - Phone:786-774-0294
Mailing Address - Fax:
Practice Address - Street 1:630 SW 39TH CT
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2008
Practice Address - Country:US
Practice Address - Phone:786-774-0294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110286500Medicaid