Provider Demographics
NPI:1871383315
Name:LOPEZ DEL CASTILLO LEDESMA, LEYANIS YISEL
Entity type:Individual
Prefix:
First Name:LEYANIS
Middle Name:YISEL
Last Name:LOPEZ DEL CASTILLO LEDESMA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15961 NW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33054-6801
Mailing Address - Country:US
Mailing Address - Phone:786-538-2308
Mailing Address - Fax:
Practice Address - Street 1:15961 NW 27TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33054-6801
Practice Address - Country:US
Practice Address - Phone:786-538-2308
Practice Address - Fax:786-538-2308
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician