Healthcare Provider Details

I. General information

NPI: 1942010699
Provider Name (Legal Business Name): MARIE MARTINEZ CASTILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 POOLSIDE DR UNIT 3
GREENACRES FL
33463-2655
US

IV. Provider business mailing address

3303 POOLSIDE DR UNIT 3
GREENACRES FL
33463-2655
US

V. Phone/Fax

Practice location:
  • Phone: 786-539-7132
  • Fax:
Mailing address:
  • Phone: 786-539-7132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2836001
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: