Provider Demographics
NPI:1104719111
Name:CASILLAS BURGOS, VANESSA VIRGINIA (SLT)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:VIRGINIA
Last Name:CASILLAS BURGOS
Suffix:
Gender:F
Credentials:SLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VILLAS DE NAVARRA
Mailing Address - Street 2:EDIF #8 APT. D
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:939-232-7113
Mailing Address - Fax:
Practice Address - Street 1:85 CALLE MAYAGUEZ
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5109
Practice Address - Country:US
Practice Address - Phone:787-455-3295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001528174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist