Individual
IONTRAY CARRILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8915 SW CENTER ST, TIGARD, OR 97223-6307
(503) 726-3690
Mailing address
8915 SW CENTER ST, TIGARD, OR 97223-6307
(503) 726-3690
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
02/02/2021
Last updated
02/02/2021
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