MEDICARE: DALLAS 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
1	374J00000X	Doula

General Provider Information

NPI Number	:	1164303814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALLAS CASILLAS

Provider Business Mailing Address
First Line	:	2873 53RD ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-4916
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2873 53RD ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-4916
Country	:	US
Telephone Number	:	619-608-8512
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2025
Last Update Date	:	09/09/2025

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Directions to “ DALLAS CASILLAS ” Practice Location

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