Individual
CARLOS CARRILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4202 W IDELL ST, TAMPA, FL 33614-2501
(813) 410-2769
(813) 490-5495
Mailing address
4202 W IDELL ST, TAMPA, FL 33614-2501
(813) 410-2769
(813) 490-5495
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
08/26/2012
Last updated
08/26/2012
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