Provider Demographics
NPI:1043996556
Name:CASILLAS, MARLEN
Entity Type:Individual
Prefix:
First Name:MARLEN
Middle Name:
Last Name:CASILLAS
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 1:1406 MOUNTAIN VIEW ST
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-1244
Mailing Address - Country:US
Mailing Address - Phone:818-926-8853
Mailing Address - Fax:
Practice Address - Street 1:1406 MOUNTAIN VIEW ST
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-1244
Practice Address - Country:US
Practice Address - Phone:818-926-8853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD1141878174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN