Healthcare Provider Details

I. General information

NPI: 1548124472
Provider Name (Legal Business Name): LEA CABRERA CASTILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4418 5TH ST W
BRADENTON FL
34207-1531
US

IV. Provider business mailing address

12508 TALL PINES WAY
LAKEWOOD RCH FL
34202-2885
US

V. Phone/Fax

Practice location:
  • Phone: 727-492-5369
  • Fax:
Mailing address:
  • Phone: 941-290-4169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-491658
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: