Healthcare Provider Details

I. General information

NPI: 1396215794
Provider Name (Legal Business Name): YINDRA CASTRO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 09/29/2026
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8126 COLONIAL VILLAGE DR APT 102
TAMPA FL
33625-3185
US

IV. Provider business mailing address

8126 COLONIAL VILLAGE DR APT 102
TAMPA FL
33625-3185
US

V. Phone/Fax

Practice location:
  • Phone: 786-416-1799
  • Fax:
Mailing address:
  • Phone: 786-416-1799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-44511
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: