Healthcare Provider Details

I. General information

NPI: 1205416641
Provider Name (Legal Business Name): YANEIVIS CASTILLO CABEZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3175 S CONGRESS AVE STE 103
PALM SPRINGS FL
33461-2502
US

IV. Provider business mailing address

1919 MOOR DR
LAKE WORTH BEACH FL
33461-5722
US

V. Phone/Fax

Practice location:
  • Phone: 561-729-6631
  • Fax: 561-771-6630
Mailing address:
  • Phone: 561-452-5167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-162391
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: