MEDICARE: MRS. LORRAINE CARRILLO-ERAZO HHA

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	374U00000X	Home Health Aide	01084066	NY
2	374U00000X	Home Health Aide	00885458	NY

General Provider Information

NPI Number	:	1386317501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LORRAINE CARRILLO-ERAZO HHA

Provider Business Mailing Address
First Line	:	1581 E 5TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6339
Country	:	US
Telephone Number	:	718-942-5312
Fax Number	:

Provider Business Practice Location Address
First Line	:	1581 E 5TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6339
Country	:	US
Telephone Number	:	718-942-5312
Fax Number	:

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

Provider Enumeration Date	:	07/26/2021
Last Update Date	:	07/26/2021

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