Provider Demographics
NPI:1306699475
Name:CASTRO FUENTES, JUAN ANTONIO (CBHCMS)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:ANTONIO
Last Name:CASTRO FUENTES
Suffix:
Gender:M
Credentials:CBHCMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0952
Mailing Address - Country:US
Mailing Address - Phone:786-342-9555
Mailing Address - Fax:
Practice Address - Street 1:200 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0952
Practice Address - Country:US
Practice Address - Phone:786-342-9555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCMS0106335101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health