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General NPI Number Information
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NPI Number | 1598025165
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Entity Type | Individual
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Provider Name | LOREN CARRILLO KING PH.D.
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Gender | Male
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Dates
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Enumeration Date | 05/16/2012
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Last Update Date | 11/29/2021
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Provider Practice Location Address
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Address Line | 3102 E HIGHLAND AVE
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City | PATTON
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State | CA
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Zip | 92369-7813
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Country | US
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Telephone | 909-425-6417
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 90824
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City | SAN BERNARDINO
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State | CA
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Zip | 92427-1824
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Country | US
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Telephone |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 24445
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License Number State | CA
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