MEDICARE: DR. LUIS FERNANDO CARRILLO FNP

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
1	363LF0000X	Family Nurse Practitioner	200550017NP	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	ANP 397	OTHER	OR	OSBN WORKER'S COMP

General Provider Information

NPI Number	:	1083617658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUIS FERNANDO CARRILLO FNP

Provider Business Mailing Address
First Line	:	6538 N KERBY AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-1939
Country	:	US
Telephone Number	:	503-283-8351
Fax Number	:

Provider Business Practice Location Address
First Line	:	6538 N KERBY AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-1939
Country	:	US
Telephone Number	:	503-283-8351
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	04/02/2025

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