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NPI Code Detail

MEDICARE: MS. MARIA GUADALUPE CARRILLO MSW

MEDICARE: MS. MARIA GUADALUPE CARRILLO MSW
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
11041C0700XClinical Social WorkerASW17653CA

General Provider Information

NPI Number : 1447315965
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARIA GUADALUPE CARRILLO MSW
Provider Business Mailing Address
First Line : 12642 GREENTREE AVE
Second Line :
City : GARDEN GROVE
State : CA
Zip : 92840-4017
Country : US
Telephone Number : 714-736-0231
Fax Number :
Provider Business Practice Location Address
First Line : 6301 BEACH BLVD STE 245
Second Line :
City : BUENA PARK
State : CA
Zip : 90621-4031
Country : US
Telephone Number : 714-736-0231
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/26/2006
Last Update Date : 07/08/2007

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