Healthcare Provider Details

I. General information

NPI: 1134571789
Provider Name (Legal Business Name): DELVIS LEMES CASTRO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2016
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18720 SW 317TH TER
HOMESTEAD FL
33030-5512
US

IV. Provider business mailing address

18720 SW 317TH TER
HOMESTEAD FL
33030-5512
US

V. Phone/Fax

Practice location:
  • Phone: 786-333-5748
  • Fax: 305-228-7009
Mailing address:
  • Phone: 786-333-5748
  • Fax: 305-228-7009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberL522-160-75-596-0
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-15-10784
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: