=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346825197
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RACHEL PEREZ CASTILLO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2021
-----------------------------------------------------
Last Update Date | 03/12/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13750 SW 258TH LN
-----------------------------------------------------
City | NARANJA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33032-6777
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-357-1409
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13750 SW 258TH LN
-----------------------------------------------------
City | NARANJA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33032-6777
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-357-1409
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number | RBT-20-116625
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------