Individual
BLAKE ERNESTO CARRILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
14150 SW 136TH ST, MIAMI, FL 33186-5506
(786) 204-4600
Mailing address
173 KINGS WAY, ROYAL PALM BEACH, FL 33411-1568
(786) 316-5665
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9107380
FL
Other
Enumeration date
09/02/2013
Last updated
04/28/2020
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