Healthcare Provider Details

I. General information

NPI: 1003487083
Provider Name (Legal Business Name): CARLOS ALEXANDER MORILLO-HERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CARLOS MORILLO

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 E BEACH ST
WATSONVILLE CA
95076-4809
US

IV. Provider business mailing address

204 E BEACH ST
WATSONVILLE CA
95076-4809
US

V. Phone/Fax

Practice location:
  • Phone: 831-728-0222
  • Fax:
Mailing address:
  • Phone: 831-728-0222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA183172
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: