Provider Demographics
NPI:1144517368
Name:CASTILLO LA FE, OLGA
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:CASTILLO LA FE
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 1:19570 NW 55TH CIRCLE PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-6185
Mailing Address - Country:US
Mailing Address - Phone:305-890-0794
Mailing Address - Fax:305-573-6888
Practice Address - Street 1:19570 NW 55TH CIRCLE PL
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-6185
Practice Address - Country:US
Practice Address - Phone:305-890-0794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106E00000X
FL15-04474106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst