Healthcare Provider Details

I. General information

NPI: 1063128759
Provider Name (Legal Business Name): MRS. ANEL VILLASENOR CARRILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. ANEL CARRILLO-ALCALA

II. Dates (important events)

Enumeration Date: 01/25/2023
Last Update Date: 01/25/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 E ALVARADO ST
FALLBROOK CA
92028-2049
US

IV. Provider business mailing address

127 W FIG ST
FALLBROOK CA
92028-2846
US

V. Phone/Fax

Practice location:
  • Phone: 760-645-3447
  • Fax:
Mailing address:
  • Phone: 442-207-9249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: