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NPI Code Detail

MEDICARE: MS. KATHY GUADALUPE CASILLAS

MEDICARE: MS. KATHY GUADALUPE CASILLAS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1134934797
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KATHY GUADALUPE CASILLAS
Provider Business Mailing Address
First Line : 3008 S SYCAMORE AVE APT 5
Second Line :
City : LOS ANGELES
State : CA
Zip : 90016-3825
Country : US
Telephone Number : 412-973-9873
Fax Number :
Provider Business Practice Location Address
First Line : 613 OCEAN PARK BLVD
Second Line :
City : SANTA MONICA
State : CA
Zip : 90405-3713
Country : US
Telephone Number : 206-841-6561
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2025
Last Update Date : 02/11/2025

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