Individual
BRIAN ANTHONY CARRILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4445 MAGNOLIA AVE, RIVERSIDE, CA 92501-4135
(951) 788-3000
Mailing address
4445 MAGNOLIA AVE, RIVERSIDE, CA 92501-4135
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
54187
CA
Other
Enumeration date
05/27/2016
Last updated
02/15/2017
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