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NPI Code Detail

MEDICARE: DR. JUAN M CARRILLO M.D.

MEDICARE: DR. JUAN M CARRILLO M.D.
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
1174400000XSpecialistG 80972CA

General Provider Information

NPI Number : 1619398252
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JUAN M CARRILLO M.D.
Provider Business Mailing Address
First Line : 1104 N MISSION RD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90033-1017
Country : US
Telephone Number : 323-343-0520
Fax Number : 323-225-2752
Provider Business Practice Location Address
First Line : 1104 N MISSION RD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90033-1017
Country : US
Telephone Number : 323-343-0520
Fax Number : 323-225-2752
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2013
Last Update Date : 12/28/2013

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