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General NPI Number Information
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NPI Number | 1225054927
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Entity Type | Organization
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Legal Business Name | ANNA CARRILLO, M.D., A MEDICAL CORPORATION
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 11665 AVENA PL STE 204
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City | SAN DIEGO
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State | CA
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Zip | 92128-2428
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Country | US
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Telephone | 858-848-4028
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Fax | 858-381-9769
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Provider Business Mailing Address
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Address Line | PO BOX 500226
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City | SAN DIEGO
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State | CA
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Zip | 92150-0226
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Country | US
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Telephone | 858-848-4028
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Fax | 858-381-9769
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANNA CARRILLO
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Credential | M.D.
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Telephone | 858-848-4028
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | A62084
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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