Individual
GUSTAVO CARRILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
610 S 200 E STE B, SALT LAKE CITY, UT 84111-3802
(602) 626-4835
Mailing address
610 S 200 E STE B, SALT LAKE CITY, UT 84111-3802
(801) 539-8617
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
12476377-1206
UT
Other
Enumeration date
06/15/2020
Last updated
12/17/2021
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