Provider Demographics
NPI:1093133407
Name:CASILANG, CLARISSE (MD)
Entity Type:Individual
Prefix:
First Name:CLARISSE
Middle Name:
Last Name:CASILANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 W COLLINS AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-5516
Mailing Address - Country:US
Mailing Address - Phone:714-509-7571
Mailing Address - Fax:
Practice Address - Street 1:810 W COLLINS AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-5516
Practice Address - Country:US
Practice Address - Phone:714-509-7571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD461711208000000X
CA144955208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics