| Doctor Name: | BRENDA CASILLAS |
| NPI Number: | 1437557790 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 246Z00000X |
| Business Practice Address: | 6333 E Skelly Dr Tulsa, OK - 741356106 |
| Business Phone Number: | 9186644224 |
| Business Fax Number: | 9186630203 |
| Mailing Address: | 2911 E 73rd Pl, TULSA |
| State: | OK |
| Postal Code: | 741365627 |
| Phone Number: | 9183328399 |
| Fax Number: | 9186630203 |
| NPI Enumeration Date: | 12/18/2014 |
| NPI Last Update Date: | 12/18/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 246Z00000X |
| License Number: | 246Z00000X |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OK |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Specialist/Technologist, Other |
| Taxonomy Specialization: | |
| Taxonomy Definition: | General classification identifying individuals trained on specific equipment and technical procedures in one of a collection of miscellaneous healthcare disciplines. |