MEDICARE: JESSICA CECILIA CARRILLO MD

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	208000000X	Pediatrics Physician	T5841	TX

General Provider Information

NPI Number	:	1598224487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA CECILIA CARRILLO MD

Provider Business Mailing Address
First Line	:	7505 MAIN ST STE 450
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-4524
Country	:	US
Telephone Number	:	713-852-6180
Fax Number	:

Provider Business Practice Location Address
First Line	:	7505 MAIN ST STE 450
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-4524
Country	:	US
Telephone Number	:	832-824-1000
Fax Number	:

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

Provider Enumeration Date	:	03/19/2019
Last Update Date	:	07/29/2022

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