Healthcare Provider Details

I. General information

NPI: 1174055511
Provider Name (Legal Business Name): MAGGIE CASTRO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 04/11/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20044 NW 64TH COURT RD
HIALEAH FL
33015-2174
US

IV. Provider business mailing address

20044 NW 64TH COURT RD
HIALEAH FL
33015-2174
US

V. Phone/Fax

Practice location:
  • Phone: 786-296-2948
  • Fax:
Mailing address:
  • Phone: 786-296-2948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-44066
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: