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NPI Code Detail

MEDICARE: ELVIS CARRILLO

MEDICARE: ELVIS CARRILLO
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
1373H00000XDay Training/Habilitation Specialist
2172V00000XCommunity Health WorkerCA

General Provider Information

NPI Number : 1134772569
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELVIS CARRILLO
Provider Business Mailing Address
First Line : 225 S LAKE AVE STE 200
Second Line :
City : PASADENA
State : CA
Zip : 91101-3009
Country : US
Telephone Number : 626-432-7270
Fax Number :
Provider Business Practice Location Address
First Line : 225 S LAKE AVE STE 200
Second Line :
City : PASADENA
State : CA
Zip : 91101-3009
Country : US
Telephone Number : 626-432-7270
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2019
Last Update Date : 05/06/2025

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Directions to “ ELVIS CARRILLO ” Practice Location

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