Individual
MR. MATTHEW MANUEL CARRILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OWNER
Contact information
Practice address
434 S 13TH AVE, LAUREL, MS 39440-4345
(601) 649-0001
(601) 649-0035
Mailing address
PO BOX 6501, LAUREL, MS 39441-6501
(601) 649-0001
(601) 649-0035
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
07014/11.1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01339261
—
MS
Enumeration date
06/17/2006
Last updated
11/07/2007
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