Provider Demographics
NPI:1467825208
Name:ZEPEDA-CASILLAS, ELSA
Entity Type:Individual
Prefix:
First Name:ELSA
Middle Name:
Last Name:ZEPEDA-CASILLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 N WASHINGTON BLVD
Mailing Address - Street 2:TRLR 139
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-3200
Mailing Address - Country:US
Mailing Address - Phone:801-678-0279
Mailing Address - Fax:
Practice Address - Street 1:1435 UNIVERSITY BLVD
Practice Address - Street 2:DEPT. 2805
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84408-0001
Practice Address - Country:US
Practice Address - Phone:801-626-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer