MEDICARE: DR. JORGE HERNANDO CARRILLO PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	24411	TX
2	103TS0200X	School Psychologist	6244	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174627186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORGE HERNANDO CARRILLO PH.D.

Provider Business Mailing Address
First Line	:	7826 HILLMONT ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77040-6108
Country	:	US
Telephone Number	:	713-939-1229
Fax Number	:	713-939-1569

Provider Business Practice Location Address
First Line	:	7826 HILLMONT ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77040-6108
Country	:	US
Telephone Number	:	713-939-1229
Fax Number	:	713-939-1569

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2006
Last Update Date	:	12/19/2024

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