Healthcare Provider Details

I. General information

NPI: 1053225524
Provider Name (Legal Business Name): JOCELINE CARRILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13210 FLORENCE AVE
SANTA FE SPRINGS CA
90670-4510
US

IV. Provider business mailing address

175 S HOLLY AVE
COMPTON CA
90221-3501
US

V. Phone/Fax

Practice location:
  • Phone: 562-574-2637
  • Fax:
Mailing address:
  • Phone: 562-374-0745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: