Provider Demographics
NPI:1134144728
Name:CASILLAS, ESIQUIO GUSTAVO (MD)
Entity Type:Individual
Prefix:DR
First Name:ESIQUIO
Middle Name:GUSTAVO
Last Name:CASILLAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5700 CANOGA AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6579
Mailing Address - Country:US
Mailing Address - Phone:818-595-8100
Mailing Address - Fax:818-595-8206
Practice Address - Street 1:5700 CANOGA AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-6579
Practice Address - Country:US
Practice Address - Phone:818-595-8100
Practice Address - Fax:818-595-8206
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA79912207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI02070Medicare UPIN