Provider Demographics
NPI:1104437888
Name:ELIAS CASTRO, ANGEL RAUL
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:RAUL
Last Name:ELIAS CASTRO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16424 SW 304TH ST APT 104
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-3229
Mailing Address - Country:US
Mailing Address - Phone:786-339-3530
Mailing Address - Fax:
Practice Address - Street 1:16424 SW 304TH ST APT 104
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-3229
Practice Address - Country:US
Practice Address - Phone:786-339-3530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician