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General NPI Number Information
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NPI Number | 1053891101
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Entity Type | Individual
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Provider Name | ADRIYEL ANGEL CARRILLO
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Gender | Male
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Dates
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Enumeration Date | 08/17/2018
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Last Update Date | 09/16/2024
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Provider Practice Location Address
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Address Line | 8200 WESTMINSER BLVD
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City | WESTMINSTER
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State | CA
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Zip | 92683
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Country | US
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Telephone | 949-591-2702
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Fax |
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Provider Business Mailing Address
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Address Line | 3924 RIVERVIEW DR
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City | JURUPA VALLEY
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State | CA
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Zip | 92509-6611
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Country | US
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Telephone | 951-360-4175
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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