Healthcare Provider Details

I. General information

NPI: 1063391662
Provider Name (Legal Business Name): DINA GISEL CASTRO LORENTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17500 SW 153RD PATH
MIAMI FL
33187-6305
US

IV. Provider business mailing address

17500 SW 153RD PATH
MIAMI FL
33187-6305
US

V. Phone/Fax

Practice location:
  • Phone: 786-813-2468
  • Fax:
Mailing address:
  • Phone: 786-813-2468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-442820
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: