Provider Demographics
NPI:1316295710
Name:CASILLAS, ROSEMARIE (IBCLC)
Entity type:Individual
Prefix:MRS
First Name:ROSEMARIE
Middle Name:
Last Name:CASILLAS
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 NELLYWOOD CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-2631
Mailing Address - Country:US
Mailing Address - Phone:702-592-7673
Mailing Address - Fax:
Practice Address - Street 1:56 NELLYWOOD CT
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-6921
Practice Address - Country:US
Practice Address - Phone:702-592-7673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN