Healthcare Provider Details

I. General information

NPI: 1194560474
Provider Name (Legal Business Name): DANIEL PATRICIO CARRILLO GONZALEZ CAA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

4830 NW 43RD ST APT F83
GAINESVILLE FL
32606-4404
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0111
  • Fax:
Mailing address:
  • Phone: 801-637-7399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA948
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: