Provider Demographics
NPI:1417451089
Name:CASELLAS, NICOLAS JAVIER (MD)
Entity type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:JAVIER
Last Name:CASELLAS
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:S9 CALLE JARDIN
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-2112
Mailing Address - Country:US
Mailing Address - Phone:305-243-3564
Mailing Address - Fax:
Practice Address - Street 1:30 CALLE TERESA JORNET STE 114
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-7666
Practice Address - Country:US
Practice Address - Phone:787-410-1464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-20
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME162825207Y00000X
PR23579207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology