Provider Demographics
NPI:1295764918
Name:CASILLAS-CALLEROS, ANA A (MFT)
Entity type:Individual
Prefix:MRS
First Name:ANA
Middle Name:A
Last Name:CASILLAS-CALLEROS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6475 ALVARADO RD
Mailing Address - Street 2:SUITE 233
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-5003
Mailing Address - Country:US
Mailing Address - Phone:858-279-1223
Mailing Address - Fax:619-229-2333
Practice Address - Street 1:6475 ALVARADO RD
Practice Address - Street 2:SUITE 233
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5003
Practice Address - Country:US
Practice Address - Phone:858-279-1223
Practice Address - Fax:619-229-2333
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39741106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist