Provider Demographics
NPI:1487461737
Name:CASTELLANO, DIEGO
Entity type:Individual
Prefix:
First Name:DIEGO
Middle Name:
Last Name:CASTELLANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DIEGO
Other - Middle Name:ANDRES
Other - Last Name:CASTELLANO CORRO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10410 W OKEECHOBEE RD APT 1107
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-1920
Mailing Address - Country:US
Mailing Address - Phone:786-665-2541
Mailing Address - Fax:
Practice Address - Street 1:10410 W OKEECHOBEE RD APT 1107
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-1920
Practice Address - Country:US
Practice Address - Phone:786-665-2541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1229056106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician