Healthcare Provider Details

I. General information

NPI: 1649611716
Provider Name (Legal Business Name): MISS ISIS B. CASILLAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2013
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9415 SW 72ND ST STE 131
MIAMI FL
33173-5492
US

IV. Provider business mailing address

8980 W FLAGLER ST APT. 108
MIAMI FL
33174-3963
US

V. Phone/Fax

Practice location:
  • Phone: 305-662-6448
  • Fax:
Mailing address:
  • Phone: 786-280-8505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: