Healthcare Provider Details

I. General information

NPI: 1457122020
Provider Name (Legal Business Name): LIANIS ILEANA CASTILLO BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2024
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 W 50TH ST
HIALEAH FL
33012-3440
US

IV. Provider business mailing address

1453 W 29 ST APT 211
HIALEAH FL
33012
US

V. Phone/Fax

Practice location:
  • Phone: 305-231-3371
  • Fax:
Mailing address:
  • Phone: 786-461-0347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-25-16533
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: