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General NPI Number Information
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NPI Number | 1174299986
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Entity Type | Individual
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Provider Name | MARIE CLAUDIA CARRILLO PTA
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Gender | Female
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Dates
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Enumeration Date | 08/20/2021
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Last Update Date | 08/24/2021
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Provider Practice Location Address
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Address Line | 20211 PATIO DR STE 205
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-4338
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Country | US
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Telephone | 510-537-3991
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Fax |
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Provider Business Mailing Address
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Address Line | 1244 LAKE ST
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City | MILLBRAE
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State | CA
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Zip | 94030-2926
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Country | US
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Telephone | 323-819-5223
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 51399
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License Number State | CA
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