Healthcare Provider Details

I. General information

NPI: 1467935007
Provider Name (Legal Business Name): CAROL CARRILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10230 ARTESIA BLVD # S104
BELLFLOWER CA
90706-6763
US

IV. Provider business mailing address

10230 ARTESIA BLVD # S104
BELLFLOWER CA
90706-6763
US

V. Phone/Fax

Practice location:
  • Phone: 562-356-9692
  • Fax:
Mailing address:
  • Phone: 562-356-9692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: