Basic Information
| Provider Information | |||||||||
| NPI: | 1083362958 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASTRO | ||||||||
| FirstName: | NAOMI | ||||||||
| MiddleName: | ILENE | ||||||||
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| Credential: | RBT, SLPA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4780 DATA CT | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328178331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4079040133 | ||||||||
| FaxNumber: | 4072504833 | ||||||||
| Practice Location | |||||||||
| Address1: | 4680 LAKE UNDERHILL RD | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328071182 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4079040137 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2022 | ||||||||
| LastUpdateDate: | 10/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | RBT-21-180308 | FL | N | 2355S0801X | SI5781 | FL | Y | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant |
ID Information
| ID | Type | State | Issuer | Description | 111453100 | 05 | FL | MEDICAID |