Healthcare Provider Details

I. General information

NPI: 1942116694
Provider Name (Legal Business Name): ISAAC CARRILLO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11517 15TH AVE
LEMOORE CA
93245-9508
US

IV. Provider business mailing address

PO BOX 182
ARMONA CA
93202-0182
US

V. Phone/Fax

Practice location:
  • Phone: 559-380-0800
  • Fax:
Mailing address:
  • Phone: 559-794-1003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: