MEDICARE: DR. DIANA KIRALYFALVI CASILLAS AUD.

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	231H00000X	Audiologist	AU-1488	CA

General Provider Information

NPI Number	:	1548922388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANA KIRALYFALVI CASILLAS AUD.

Provider Business Mailing Address
First Line	:	255 PICO AVE STE 200
Second Line	:
City	:	SAN MARCOS
State	:	CA
Zip	:	92069-3709
Country	:	US
Telephone Number	:	760-307-1337
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 PICO AVE STE 200
Second Line	:
City	:	SAN MARCOS
State	:	CA
Zip	:	92069-3709
Country	:	US
Telephone Number	:	760-307-1337
Fax Number	:	760-591-3510

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

Provider Enumeration Date	:	10/08/2021
Last Update Date	:	10/08/2021

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