MEDICARE: MRS. ZULMA CARRILLO D.O

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	103TC0700X	Clinical Psychologist	2533	PR

General Provider Information

NPI Number	:	1104851781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ZULMA CARRILLO D.O

Provider Business Mailing Address
First Line	:	PO BOX 8056
Second Line	:
City	:	HUMACAO
State	:	PR
Zip	:	00792-8056
Country	:	US
Telephone Number	:	787-309-3412
Fax Number	:	787-739-8190

Provider Business Practice Location Address
First Line	:	CALLE FRANCISCO HADDOCK 1330
Second Line	:
City	:	CIDRA
State	:	PR
Zip	:	00739
Country	:	US
Telephone Number	:	787-739-8182
Fax Number	:	787-739-8120

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	12/20/2007

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