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General NPI Number Information
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NPI Number | 1215589312
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Entity Type | Individual
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Provider Name | OSVALDO GARCIA CARRILLO SLP
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Gender | Male
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Dates
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Enumeration Date | 07/10/2019
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Last Update Date | 07/10/2019
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Provider Practice Location Address
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Address Line | BALANTOLELLESTRASSE 14
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City | MIESENBACH
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State | RHEINLAND-PFALZ
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Zip | 66877
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Country | DE
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Telephone | 919-897-9103
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Fax |
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Provider Business Mailing Address
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Address Line | PSC 2 BOX 7173
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City | APO
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State | AE
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Zip | 09012-0072
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Country | US
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Telephone | 919-897-9103
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 00820
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License Number State | PR
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