Provider Demographics
NPI:1578312369
Name:MENDEZ CASTELLANOS, CARLOS MOISES
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:MOISES
Last Name:MENDEZ CASTELLANOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 W 41ST PL
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4177
Mailing Address - Country:US
Mailing Address - Phone:786-593-3556
Mailing Address - Fax:
Practice Address - Street 1:1133 W 41ST PL
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4177
Practice Address - Country:US
Practice Address - Phone:786-593-3556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical