Individual
IRIS MAE CANETE TRINIDAD-CARILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
INTERSECTION OF RT. 4 & 20 S, ROCK CAVE, WV 26234-0217
(304) 924-6262
(304) 924-6699
Mailing address
PO BOX 217, INTERSECTION OF RT. 4 & 20 SOUTH, ROCK CAVE, WV 26234-0217
(304) 924-6262
(304) 924-6699
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
24962
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
24962
WV STATE LICENSE
WV
Enumeration date
07/02/2009
Last updated
08/02/2012
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