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General NPI Number Information
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NPI Number | 1477918969
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Entity Type | Organization
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Legal Business Name | MICHELLE CARRILLO-MASSA, M.D., P.A.
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Dates
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Enumeration Date | 12/28/2015
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Last Update Date | 12/28/2015
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Provider Practice Location Address
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Address Line | 11211 PROSPERITY FARMS RD SUITE D127
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-3446
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Country | US
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Telephone | 561-627-0990
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Fax | 561-625-0248
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Provider Business Mailing Address
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Address Line | 1383 DAKOTA DR
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City | JUPITER
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State | FL
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Zip | 33458-8407
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Country | US
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Telephone | 561-385-7591
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Fax | 561-625-0248
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Authorized Official
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Title or Position | OWNER/MEDICAL DOCTOR
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Name | MICHELLE CARRILLO-MASSA
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Credential | M.D.
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Telephone | 561-385-7591
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME115891
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License Number State | FL
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