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General NPI Number Information
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NPI Number | 1932124377
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Entity Type | Individual
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Provider Name | PETER CARRILLO PT
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Gender | Male
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 03/05/2019
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Provider Practice Location Address
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Address Line | 2595 W FLORIDA AVE
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City | HEMET
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State | CA
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Zip | 92545-4615
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Country | US
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Telephone | 951-487-9317
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Fax | 951-487-9371
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Provider Business Mailing Address
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Address Line | 38072 AMATEUR WAY
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City | BEAUMONT
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State | CA
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Zip | 92223-8086
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Country | US
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Telephone | 909-489-5971
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT26426
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License Number State | CA
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