Healthcare Provider Details

I. General information

NPI: 1114703394
Provider Name (Legal Business Name): ANGELINI CASTILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2023
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4727 W IRLO BRONSON MEMORIAL HWY
KISSIMMEE FL
34746-5326
US

IV. Provider business mailing address

3390 TIMUCUA CIR
ORLANDO FL
32837-7131
US

V. Phone/Fax

Practice location:
  • Phone: 407-978-6085
  • Fax:
Mailing address:
  • Phone: 407-978-6085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: