Individual
DR. ALFONSO JULIUS CARRILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8599 HAVEN AVE., SUITE 300, RANCHO CUCAMONGA, CA 91730-4849
(909) 620-8180
(909) 919-7288
Mailing address
8599 HAVEN AVE., SUITE 300, RANCHO CUCAMONGA, CA 91730-4849
(909) 620-8180
(909) 919-7288
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
25000064
OH
2085R0202X
Diagnostic Radiology Physician
Primary
G77083
CA
2085U0001X
Diagnostic Ultrasound Physician
25000064
OH
2085U0001X
Diagnostic Ultrasound Physician
G77083
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000500781
ANTHEM
OH
05
—
00G770830
—
CA
05
—
2694660
—
OH
01
—
P00383076
RR MEDICARE
OH
Enumeration date
03/22/2006
Last updated
03/21/2012
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