Healthcare Provider Details

I. General information

NPI: 1962348698
Provider Name (Legal Business Name): MIKAELA RENEE CARRILLO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 ALHAMBRA BLVD STE 300
SACRAMENTO CA
95816-5241
US

IV. Provider business mailing address

1201 ALHAMBRA BLVD STE 340
SACRAMENTO CA
95816-5242
US

V. Phone/Fax

Practice location:
  • Phone: 916-731-7866
  • Fax:
Mailing address:
  • Phone: 916-731-7866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21676
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: