Vanessa Virginia Casillas Burgos, SLT
Individual provider Active NPI Specialist · San Juan, PR
NPI 1104719111 · NPPES record last updated May 29, 2025
Key facts
- NPI
- 1104719111
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 001528 (PR)
- Practice address
- 85 Calle Mayaguez
San Juan, PR 00917-5109 - Phone
- (787) 455-3295
- NPI assigned
- May 29, 2025
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001528 | PR | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 001528 | PR | Yes |
Addresses
Primary practice location
85 Calle Mayaguez
San Juan, PR 00917-5109
Mailing address
Villas de Navarra
Edif #8 Apt. D
Bayamon, PR 00956
Phone (939) 232-7113
Other providers in San Juan, PR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 29, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.