Provider Demographics
NPI:1811130941
Name:CASILLAS-HARRIS, MYRNA VERONICA
Entity type:Individual
Prefix:
First Name:MYRNA
Middle Name:VERONICA
Last Name:CASILLAS-HARRIS
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 1:14677 MERRILL AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-4219
Mailing Address - Country:US
Mailing Address - Phone:951-643-2340
Mailing Address - Fax:951-543-9645
Practice Address - Street 1:14677 MERRILL AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-4219
Practice Address - Country:US
Practice Address - Phone:951-643-2340
Practice Address - Fax:951-543-9645
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2023-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator