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General NPI Number Information
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NPI Number | 1104719111
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Entity Type | Individual
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Provider Name | VANESSA VIRGINIA CASILLAS BURGOS SLT
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Gender | Female
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Dates
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Enumeration Date | 05/29/2025
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 85 CALLE MAYAGUEZ
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City | SAN JUAN
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State | PR
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Zip | 00917-5109
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Country | US
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Telephone | 787-455-3295
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Fax |
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Provider Business Mailing Address
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Address Line | VILLAS DE NAVARRA EDIF #8 APT. D
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City | BAYAMON
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State | PR
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Zip | 00956
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Country | US
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Telephone | 939-232-7113
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 001528
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License Number State | PR
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