Provider Demographics
NPI:1548032253
Name:FAUBEL CASTRO, LINA MARIA
Entity type:Individual
Prefix:
First Name:LINA
Middle Name:MARIA
Last Name:FAUBEL CASTRO
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 1:13200 SW 51ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-5210
Mailing Address - Country:US
Mailing Address - Phone:786-274-9121
Mailing Address - Fax:
Practice Address - Street 1:1813 NE 163RD ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4805
Practice Address - Country:US
Practice Address - Phone:305-399-4652
Practice Address - Fax:305-402-2203
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-25
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB606375106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician