Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1083119952 |
---|---|
Provider Name | Luis Normando Castro |
First Address | Orlando, FL 32809-6747 |
Second Address | Orlando, FL 32809-6747 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2018 |
Last Update Date | 24/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
018742300 | (05) | FL |