Individual
BRENDA CASILLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8233 E STOCKTON BLVD STE D, SACRAMENTO, CA 95828-8203
(916) 368-3080
Mailing address
7668 BILLINGS WAY, SACRAMENTO, CA 95832-1535
(916) 214-0471
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1124112933
MEDI-CAL
CA
Enumeration date
09/30/2010
Last updated
09/30/2010
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