Healthcare Provider Details

I. General information

NPI: 1295698991
Provider Name (Legal Business Name): CECILIA CARRILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1442 S EASTERN AVE
COMMERCE CA
90040-5613
US

IV. Provider business mailing address

1442 S EASTERN AVE
COMMERCE CA
90040-5613
US

V. Phone/Fax

Practice location:
  • Phone: 323-955-9043
  • Fax:
Mailing address:
  • Phone: 323-955-9043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: