Individual
CARRIE M CARRILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2141 N HARBOR BLVD STE 35000, FULLERTON, CA 92835-3831
(714) 626-8630
Mailing address
2141 N HARBOR BLVD STE 35000, FULLERTON, CA 92835-3831
(714) 626-8630
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA17561
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA17561
LICENSE
CA
Enumeration date
05/18/2007
Last updated
10/20/2021
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