Provider Demographics
NPI:1871528125
Name:CASILLAS, ADRIAN MARTIN (MD)
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:MARTIN
Last Name:CASILLAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11163 LA QUINTA PL STE A200
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-5257
Mailing Address - Country:US
Mailing Address - Phone:915-320-3854
Mailing Address - Fax:
Practice Address - Street 1:11163 LA QUINTA PL STE A200
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936
Practice Address - Country:US
Practice Address - Phone:915-320-3854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG63875207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3352981-06Medicaid
CAWG63875AMedicare PIN
CA00G638750Medicaid