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General NPI Number Information
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NPI Number | 1689498834
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Entity Type | Individual
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Provider Name | ADRIENNE GALLEGOS CARILLO DDS
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Gender | Female
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Dates
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Enumeration Date | 11/14/2024
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 721 W HUNTINGTON DR STE B
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City | ARCADIA
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State | CA
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Zip | 91007-6734
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Country | US
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Telephone | 626-574-1766
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Fax |
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Provider Business Mailing Address
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Address Line | 17138 GUMBINER DR
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City | LA PUENTE
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State | CA
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Zip | 91744-3311
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 110781
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License Number State | CA
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