Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | FL |
NPI | 1003384322 |
---|---|
Provider Name | Sandy Castano |
First Address | Tampa, FL 33615-4620 |
Second Address | Tampa, FL 33615-4620 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2018 |
Last Update Date | 05/11/2018 |