Healthcare Provider Details

I. General information

NPI: 1720998958
Provider Name (Legal Business Name): AMANDA MARIA CASTRO GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3206 S POLK AVE
LAKELAND FL
33803-4532
US

IV. Provider business mailing address

3206 S POLK AVE
LAKELAND FL
33803-4532
US

V. Phone/Fax

Practice location:
  • Phone: 863-274-0507
  • Fax:
Mailing address:
  • Phone: 863-274-0507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number1340900
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: