Provider Demographics
NPI:1023618162
Name:CASTRO CARUNCHO, REYDIER ALEJANDRO (RBT)
Entity type:Individual
Prefix:MR
First Name:REYDIER
Middle Name:ALEJANDRO
Last Name:CASTRO CARUNCHO
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11363 SW 148TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-7408
Mailing Address - Country:US
Mailing Address - Phone:863-440-4044
Mailing Address - Fax:
Practice Address - Street 1:11363 SW 148TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-7408
Practice Address - Country:US
Practice Address - Phone:863-440-4044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-141429106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician