Provider Demographics
NPI:1104619824
Name:CASTILLO MARTINEZ, LETISIA
Entity type:Individual
Prefix:
First Name:LETISIA
Middle Name:
Last Name:CASTILLO MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6972 NW 179TH ST APT 112
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5644
Mailing Address - Country:US
Mailing Address - Phone:305-409-6492
Mailing Address - Fax:
Practice Address - Street 1:9010 SW 137TH AVE STE 212
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1438
Practice Address - Country:US
Practice Address - Phone:786-762-2474
Practice Address - Fax:786-762-2474
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-26
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-433160106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician