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Individual
MR. JUAN CASILLAS JR.
Active
Individual
MR. JUAN CASILLAS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
593398
CA
363LF0000X
Family Nurse Practitioner
Primary
22074
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1679642326
MEDICAL PROVIDER
CA
Enumeration date
09/05/2012
Last updated
10/27/2022
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