Individual
MIRIAM CARRILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDA
Contact information
Practice address
1835 XIMENO AVE, LONG BEACH, CA 90815-2850
(562) 731-0470
Mailing address
12017 164TH ST, NORWALK, CA 90650-7245
(562) 500-0852
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
81473
CA
Other
Enumeration date
08/16/2019
Last updated
08/16/2019
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