Healthcare Provider Details

I. General information

NPI: 1952822322
Provider Name (Legal Business Name): ANA MARIA CASILLAS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 ZONAL AVE
LOS ANGELES CA
90033-1026
US

IV. Provider business mailing address

2010 ZONAL AVE
LOS ANGELES CA
90033-1026
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-4556
  • Fax: 323-226-8115
Mailing address:
  • Phone: 323-409-4556
  • Fax: 323-226-8115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number411031
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: