Provider Demographics
NPI:1952732828
Name:CASILLAS, ISMAEL
Entity Type:Individual
Prefix:
First Name:ISMAEL
Middle Name:
Last Name:CASILLAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3180 IMJIN RD STE 149
Mailing Address - Street 2:
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-5111
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1127 BALDWIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3681
Practice Address - Country:US
Practice Address - Phone:831-261-5612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-03
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician