Healthcare Provider Details

I. General information

NPI: 1851831820
Provider Name (Legal Business Name): JACQUELINE CASTELLANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2017
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21600 OXNARD ST STE 200
WOODLAND HILLS CA
91367-4971
US

IV. Provider business mailing address

3131 SW 135TH AVE
MIAMI FL
33175-6657
US

V. Phone/Fax

Practice location:
  • Phone: 877-206-1009
  • Fax:
Mailing address:
  • Phone: 786-853-6717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-48524
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: