Individual
CARLOS CARRILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
111 CORTE MESA AVE, SAN RAFAEL, CA 94901-1303
(415) 879-2525
Mailing address
111 CORTE MESA AVE, SAN RAFAEL, CA 94901-1303
(415) 879-2525
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
SRJH102516761
CA
Other
Enumeration date
06/10/2015
Last updated
06/10/2015
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