Individual
JIMMY RAFAEL CARRILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3269 HIGHWAY 90, BONIFAY, FL 32425-6001
(850) 547-9991
(850) 547-9992
Mailing address
3269 HIGHWAY 90, BONIFAY, FL 32425-6001
(850) 547-9991
(850) 547-9992
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9106175
FL
Other
Enumeration date
10/27/2011
Last updated
10/27/2011
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