Healthcare Provider Details

I. General information

NPI: 1942607205
Provider Name (Legal Business Name): RHONDA SOLEDAD CASILLAS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2014
Last Update Date: 12/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 S FOREST AVE
TEMPE AZ
85287-0001
US

IV. Provider business mailing address

1324 W BECK LN
PHOENIX AZ
85023-4455
US

V. Phone/Fax

Practice location:
  • Phone: 480-965-6146
  • Fax:
Mailing address:
  • Phone: 602-863-2188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4437
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number4437
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: