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General NPI Number Information
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NPI Number | 1407024102
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Entity Type | Individual
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Provider Name | JESUS ARTURO CARRILLO COTA/L
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Gender | Male
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Dates
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Enumeration Date | 02/14/2008
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Last Update Date | 10/15/2008
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Provider Practice Location Address
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Address Line | 6960 DESTINY DRIVE SUITE 117
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City | ROCKLIN
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State | CA
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Zip | 95677-2993
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Country | US
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Telephone | 916-532-3940
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Fax |
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Provider Business Mailing Address
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Address Line | 11713 SHERWOOD WAY
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City | AUBURN
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State | CA
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Zip | 95602
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Country | US
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Telephone | 916-532-3940
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 548
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License Number State | CA
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