Provider Demographics
NPI:1972619450
Name:CASILLAN, BERNARD ORANTE (PA)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:ORANTE
Last Name:CASILLAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5030 CAMINO DE LA SIESTA
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3117
Mailing Address - Country:US
Mailing Address - Phone:619-260-6300
Mailing Address - Fax:619-260-6313
Practice Address - Street 1:5030 CAMINO DE LA SIESTA
Practice Address - Street 2:SUITE 208
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3117
Practice Address - Country:US
Practice Address - Phone:619-260-6300
Practice Address - Fax:619-260-6313
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17367363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00204658OtherRAILROAD MEDICARE
CAPA17367Medicaid
CAR059973AOtherMEDICARE PORTABLE X-RAY
Q16786Medicare UPIN
P00204658OtherRAILROAD MEDICARE