Individual
GERTRUDE CARRILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
22722 LAMBERT ST STE 1711, LAKE FOREST, CA 92630-1618
(949) 329-8161
Mailing address
22722 LAMBERT ST STE 1711, LAKE FOREST, CA 92630-1618
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
4986
CA
Other
Enumeration date
09/08/2020
Last updated
09/08/2020
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