Provider Demographics
NPI:1881401990
Name:GOMEZ CASTRO, DALILA
Entity type:Individual
Prefix:
First Name:DALILA
Middle Name:
Last Name:GOMEZ CASTRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 NW 208TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-1241
Mailing Address - Country:US
Mailing Address - Phone:502-751-4484
Mailing Address - Fax:
Practice Address - Street 1:3511 NW 208TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-1241
Practice Address - Country:US
Practice Address - Phone:502-751-4484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician