Healthcare Provider Details

I. General information

NPI: 1750149324
Provider Name (Legal Business Name): ILIANET CASTILLA FERNANDEZ RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2024
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8935 SW 11TH ST
MIAMI FL
33174-3247
US

IV. Provider business mailing address

8935 SW 11TH ST
MIAMI FL
33174-3247
US

V. Phone/Fax

Practice location:
  • Phone: 786-637-5212
  • Fax:
Mailing address:
  • Phone: 786-637-5212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-330253
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: