Basic Information
| Provider Information | |||||||||
| NPI: | 1144252396 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ACEVES-CASILLAS | ||||||||
| FirstName: | PEDRO | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3400 DATA DR | ||||||||
| Address2: | PHYSICIAN SUPPORT SERVICES, 2ND FLOOR | ||||||||
| City: | RANCHO CORDOVA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956707956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4157505995 | ||||||||
| FaxNumber: | 4156663144 | ||||||||
| Practice Location | |||||||||
| Address1: | 2250 HAYES ST | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941171078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4157505995 | ||||||||
| FaxNumber: | 4156663144 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 10/28/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A95197 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | A95197 | 01 | CA | MEDICAL LICENSE FOR CA | OTHER |