Individual
JESUS CARRILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1175 MOUNT HOOD AVE, WOODBURN, OR 97071-9060
(503) 982-2000
Mailing address
PO BOX 190, TOPPENISH, WA 98948-0190
(509) 865-2395
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
PA222434
OR
363A00000X
Physician Assistant
Primary
PA222434
OR
Other
Enumeration date
11/22/2023
Last updated
01/15/2025
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