MEDICARE: MAYRA KYTZYA CASILLAS NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	NP95025717	CA

General Provider Information

NPI Number	:	1851174494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYRA KYTZYA CASILLAS NP

Provider Business Mailing Address
First Line	:	435 W ATEN RD STE 2
Second Line	:
City	:	IMPERIAL
State	:	CA
Zip	:	92251-9819
Country	:	US
Telephone Number	:	760-879-8590
Fax Number	:

Provider Business Practice Location Address
First Line	:	790 W ORANGE AVE STE B
Second Line	:
City	:	EL CENTRO
State	:	CA
Zip	:	92243-3274
Country	:	US
Telephone Number	:	760-353-3222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2023
Last Update Date	:	04/21/2026

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