Provider Demographics
NPI:1437875929
Name:CASILLAS MEDICAL AND WELLNESS LLC
Entity Type:Organization
Organization Name:CASILLAS MEDICAL AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CASILLAS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:407-765-6982
Mailing Address - Street 1:1706 E SEMORAN BLVD STE 118
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-5600
Mailing Address - Country:US
Mailing Address - Phone:407-765-6982
Mailing Address - Fax:407-604-6336
Practice Address - Street 1:1706 E SEMORAN BLVD STE 118
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-5600
Practice Address - Country:US
Practice Address - Phone:407-765-6982
Practice Address - Fax:407-604-6336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty