Individual
DANIELLE CASILLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1534 UNSER BLVD SE, RIO RANCHO, NM 87124-6377
(505) 298-2505
Mailing address
5904 HOLLY AVE NE, ALBUQUERQUE, NM 87113-2472
(505) 298-2505
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
RN--69713
NM
363LP0200X
Pediatric Nurse Practitioner
CNP-02663
NM
Other
Enumeration date
05/06/2015
Last updated
04/06/2021
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