Provider Demographics
NPI:1215088794
Name:CASTRO, VALENTINO (EDD)
Entity type:Individual
Prefix:DR
First Name:VALENTINO
Middle Name:
Last Name:CASTRO
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 BAYSHORE RD LOT 711
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-9356
Mailing Address - Country:US
Mailing Address - Phone:941-448-9115
Mailing Address - Fax:941-212-1113
Practice Address - Street 1:5700 BAYSHORE RD LOT 711
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-9356
Practice Address - Country:US
Practice Address - Phone:941-448-9115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS1550103T00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114702400Medicaid