Healthcare Provider Details

I. General information

NPI: 1003496969
Provider Name (Legal Business Name): MR. JESUS E JUAREZ CASILLAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18092 WIKA RD STE 140
APPLE VALLEY CA
92307-2132
US

IV. Provider business mailing address

PO BOX 10297
BAKERSFIELD CA
93389-0297
US

V. Phone/Fax

Practice location:
  • Phone: 760-503-5910
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberA181022
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: