Individual
MARITZA ELIDE CARRILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1906 BELLEVIEW AVE SE, ROANOKE, VA 24014-1838
(540) 981-7000
Mailing address
10790 RANCHO BERNARDO RD, SAN DIEGO, CA 92127-5705
(858) 824-5335
(858) 964-3131
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
163183
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/01/2016
Last updated
07/01/2021
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