Healthcare Provider Details

I. General information

NPI: 1851211478
Provider Name (Legal Business Name): CARLA CARRILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 AMY ST APT 6
WEST LINN OR
97068-3368
US

IV. Provider business mailing address

5250 AMY ST APT 6
WEST LINN OR
97068-3368
US

V. Phone/Fax

Practice location:
  • Phone: 800-545-0999
  • Fax:
Mailing address:
  • Phone: 800-545-0999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: