Provider Demographics
NPI:1124416425
Name:SANCHEZ CASILLAS, BRENDA CRISTINA (RDHAP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:CRISTINA
Last Name:SANCHEZ CASILLAS
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:MS
Other - First Name:BRENDA
Other - Middle Name:
Other - Last Name:CASILLAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3744 PIER WALK
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93035-1634
Mailing Address - Country:US
Mailing Address - Phone:805-469-3699
Mailing Address - Fax:
Practice Address - Street 1:3744 PIER WALK
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93035-1634
Practice Address - Country:US
Practice Address - Phone:805-469-3699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-08
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA449124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist