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Individual

LISETTE CARRILLO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
6333 TELEGRAPH AVE, OAKLAND, CA 94609-1359
(510) 923-1099
(510) 923-0894
Mailing address
6333 TELEGRAPH AVE, OAKLAND, CA 94609-1359
(510) 923-1099
(510) 923-0894

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000111
MEDI-CAL
CA
Enumeration date
10/30/2020
Last updated
10/30/2020
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