Healthcare Provider Details

I. General information

NPI: 1659079671
Provider Name (Legal Business Name): NALTY CASTRO TORRES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7340 SW 48TH ST STE 107
MIAMI FL
33155-5520
US

IV. Provider business mailing address

12319 SW 110TH S CANAL STREET RD
MIAMI FL
33186-4801
US

V. Phone/Fax

Practice location:
  • Phone: 786-227-6830
  • Fax:
Mailing address:
  • Phone: 786-277-8396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-124716
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: