Provider Demographics
NPI:1104375146
Name:CASANADA, GUILLERMO DELGADO JR (PT, DPT)
Entity Type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:DELGADO
Last Name:CASANADA
Suffix:JR
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 AVENIDA PANTERA
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-7389
Mailing Address - Country:US
Mailing Address - Phone:760-685-3186
Mailing Address - Fax:
Practice Address - Street 1:353 E PARK AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-3988
Practice Address - Country:US
Practice Address - Phone:619-334-4294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292121225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist