Provider Demographics
NPI:1588389258
Name:CASTILLO, ASLY MANUEL
Entity type:Individual
Prefix:
First Name:ASLY
Middle Name:MANUEL
Last Name:CASTILLO
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 1:13006 CARROLLWOOD CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-4028
Mailing Address - Country:US
Mailing Address - Phone:813-484-6549
Mailing Address - Fax:
Practice Address - Street 1:9225 BAY PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-4466
Practice Address - Country:US
Practice Address - Phone:813-440-4933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician