Provider Demographics
NPI:1083334536
Name:CASILLAS MANGUAL, MYRELIZ (DC)
Entity Type:Individual
Prefix:DR
First Name:MYRELIZ
Middle Name:
Last Name:CASILLAS MANGUAL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30000
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-0013
Mailing Address - Country:US
Mailing Address - Phone:787-313-1607
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 958 MK 5.7 PALMASOLA
Practice Address - Street 2:
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-0013
Practice Address - Country:US
Practice Address - Phone:787-313-1607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-02
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR854111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor