Healthcare Provider Details

I. General information

NPI: 1255252672
Provider Name (Legal Business Name): ISAIAH CASSILLAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 REDONDO AVE FL 5
LONG BEACH CA
90806-2325
US

IV. Provider business mailing address

9639 BLACKLEY ST
TEMPLE CITY CA
91780-3852
US

V. Phone/Fax

Practice location:
  • Phone: 844-562-1212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95414153
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: