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NPI Code Detail

MEDICARE: MYRNA VERONICA CASILLAS-HARRIS

MEDICARE: MYRNA VERONICA CASILLAS-HARRIS
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1811130941
Entity Type Code : Individual
Provider Name (Legal Business Name) : MYRNA VERONICA CASILLAS-HARRIS
Provider Business Mailing Address
First Line : 14677 MERRILL AVE
Second Line :
City : FONTANA
State : CA
Zip : 92335-4219
Country : US
Telephone Number : 951-643-2340
Fax Number : 951-543-9645
Provider Business Practice Location Address
First Line : 14677 MERRILL AVE
Second Line :
City : FONTANA
State : CA
Zip : 92335-4219
Country : US
Telephone Number : 951-643-2340
Fax Number : 951-543-9645
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2009
Last Update Date : 04/16/2023

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Directions to “ MYRNA VERONICA CASILLAS-HARRIS ” Practice Location

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