Organization
ICHOR SPORTS MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ERIBERTO CASILLAS AT,CSCS (DIRECTOR SPORTS MEDICINE)
(760) 209-4419
Entity
Organization
Contact information
Practice address
38397 INNOVATION CT, SUITE 104, MURRIETA, CA 92563-2630
(951) 888-2323
Mailing address
38397 INNOVATION CT, SUITE 104, MURRIETA, CA 92563-2630
(951) 888-2323
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
08/22/2011
Last updated
12/28/2016
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