Individual
MRS. AIRENE AMBULO CARRILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
18 SONOMA AVE, GOLETA, CA 93117-1402
(559) 824-9728
Mailing address
18 SONOMA AVE, GOLETA, CA 93117-1402
(559) 824-9728
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT28366
CA
Other
Enumeration date
11/03/2018
Last updated
11/03/2018
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