Healthcare Provider Details

I. General information

NPI: 1568276285
Provider Name (Legal Business Name): GIOVANNI ALFONSO CASTRO RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N PARK RD STE 400
HOLLYWOOD FL
33021-6918
US

IV. Provider business mailing address

9038 NW 120TH TER
HIALEAH GARDENS FL
33018-4171
US

V. Phone/Fax

Practice location:
  • Phone: 954-925-3191
  • Fax:
Mailing address:
  • Phone: 954-559-9674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-403195
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: