Healthcare Provider Details

I. General information

NPI: 1700606985
Provider Name (Legal Business Name): LAZARA MARISEL CASTELLANOS DANIEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8803 TAMIAMI TRL E
NAPLES FL
34113-3347
US

IV. Provider business mailing address

4148 32ND AVE SW
NAPLES FL
34116-8316
US

V. Phone/Fax

Practice location:
  • Phone: 239-272-0838
  • Fax: 239-310-2045
Mailing address:
  • Phone: 239-371-1494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-381166
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: