1750503256 NPI number — MISS NEITZA DARLENE CASILLAS MSW

Table of content: MISS NEITZA DARLENE CASILLAS MSW (NPI 1750503256)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750503256 NPI number — MISS NEITZA DARLENE CASILLAS MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASILLAS
Provider First Name:
NEITZA
Provider Middle Name:
DARLENE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CASILLAS
Provider Other First Name:
NEITZA
Provider Other Middle Name:
DARLENE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1750503256
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
VILLA CAROLINA CALLE 609
Provider Second Line Business Mailing Address:
BLOQUE 231 CASA 5
Provider Business Mailing Address City Name:
CAROLINA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00985
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-752-5380
Provider Business Mailing Address Fax Number:
787-763-7515

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE 609 VILLA CAROLINA
Provider Second Line Business Practice Location Address:
BLOQUE 231 CASA 5
Provider Business Practice Location Address City Name:
CAROLINA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00985
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-752-5380
Provider Business Practice Location Address Fax Number:
787-763-7515
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  14651 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9568 . This is a "CLINIC" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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