Provider Demographics
NPI:1477680940
Name:CASILLAS, ERIBERTO (ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:ERIBERTO
Middle Name:
Last Name:CASILLAS
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38397 INNOVATION CT
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-2630
Mailing Address - Country:US
Mailing Address - Phone:951-888-2323
Mailing Address - Fax:951-575-3626
Practice Address - Street 1:38397 INNOVATION CT
Practice Address - Street 2:SUITE 106
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2630
Practice Address - Country:US
Practice Address - Phone:951-290-8007
Practice Address - Fax:951-575-3626
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL22302255A2300X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer