Healthcare Provider Details

I. General information

NPI: 1285153700
Provider Name (Legal Business Name): YADIRA ANNAI CASTILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2017
Last Update Date: 04/03/2021
Certification Date: 04/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 UNIVERSITY BLVD W
SILVER SPRING MD
20901
US

IV. Provider business mailing address

344 UNIVERSITY BLVD W
SILVER SPRING MD
20901-1948
US

V. Phone/Fax

Practice location:
  • Phone: 202-779-1856
  • Fax:
Mailing address:
  • Phone: 202-779-1856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number24103
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: