Provider Demographics
NPI:1871378299
Name:ROBAU CASTILLO, YAIMARA
Entity type:Individual
Prefix:
First Name:YAIMARA
Middle Name:
Last Name:ROBAU CASTILLO
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 1:777 SW 111TH WAY APT 203-8
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-7028
Mailing Address - Country:US
Mailing Address - Phone:954-446-5751
Mailing Address - Fax:
Practice Address - Street 1:777 SW 111TH WAY APT 203-8
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-7028
Practice Address - Country:US
Practice Address - Phone:954-446-5751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-25
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-282032106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician