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NPI Code Detail

MEDICARE: DR. AMANDA JUSTINE CARRILLO DPT

MEDICARE: DR. AMANDA JUSTINE CARRILLO DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist42031CA

General Provider Information

NPI Number : 1073902706
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AMANDA JUSTINE CARRILLO DPT
Provider Business Mailing Address
First Line : 645 E CALAVERAS BLVD
Second Line :
City : MILPITAS
State : CA
Zip : 95035-7705
Country : US
Telephone Number : 408-325-6251
Fax Number : 408-325-6281
Provider Business Practice Location Address
First Line : 645 E CALAVERAS BLVD
Second Line :
City : MILPITAS
State : CA
Zip : 95035-7705
Country : US
Telephone Number : 408-325-6251
Fax Number : 408-325-6281
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2015
Last Update Date : 04/13/2024

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