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General NPI Number Information
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NPI Number | 1609587831
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Entity Type | Individual
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Provider Name | HECTOR CARRILLO JR. OD
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Gender | Male
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Dates
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Enumeration Date | 12/08/2022
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 1120 W LA VETA AVE STE 100
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City | ORANGE
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State | CA
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Zip | 92868-4215
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Country | US
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Telephone | 714-509-4490
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Fax |
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Provider Business Mailing Address
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Address Line | 15021 ELMBROOK DR
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City | LA MIRADA
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State | CA
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Zip | 90638-4702
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Country | US
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Telephone | 562-305-7539
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 35503
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License Number State | CA
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