Healthcare Provider Details

I. General information

NPI: 1265351472
Provider Name (Legal Business Name): LUIS PEDRO CASILLAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20124 MARILLA ST
CHATSWORTH CA
91311-5421
US

IV. Provider business mailing address

20124 MARILLA ST
CHATSWORTH CA
91311-5421
US

V. Phone/Fax

Practice location:
  • Phone: 818-915-9016
  • Fax:
Mailing address:
  • Phone: 818-915-9016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number021538
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: