Provider Demographics
NPI:1467055046
Name:SIGALA-CASILLAS, PABLO EDUARDO (MSW)
Entity Type:Individual
Prefix:
First Name:PABLO
Middle Name:EDUARDO
Last Name:SIGALA-CASILLAS
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1449 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92411-2107
Mailing Address - Country:US
Mailing Address - Phone:909-541-7790
Mailing Address - Fax:
Practice Address - Street 1:1449 W 10TH ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411-2107
Practice Address - Country:US
Practice Address - Phone:909-541-7790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAACSW83602104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker