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General NPI Number Information
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NPI Number | 1578354577
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Entity Type | Individual
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Provider Name | TINA PASILLAS
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Gender | Female
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Dates
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Enumeration Date | 05/16/2025
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 738 S BRIDGEWAY PL STE 150
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City | EAGLE
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State | ID
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Zip | 83616-6953
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Country | US
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Telephone | 888-392-8642
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Fax |
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Provider Business Mailing Address
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Address Line | 1283 CALDWELL BLVD
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City | NAMPA
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State | ID
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Zip | 83651-1071
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Country | US
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Telephone |
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 25-436634
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License Number State |
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