Provider Demographics
NPI:1043923493
Name:CARRILLO GODINEZ CARMONA, MARIA DE JESUS
Entity Type:Individual
Prefix:
First Name:MARIA DE JESUS
Middle Name:
Last Name:CARRILLO GODINEZ CARMONA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIA DE JESUS
Other - Middle Name:
Other - Last Name:CARRILLO GODINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:339 PAJARO ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3400
Mailing Address - Country:US
Mailing Address - Phone:831-540-5922
Mailing Address - Fax:
Practice Address - Street 1:339 PAJARO ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3400
Practice Address - Country:US
Practice Address - Phone:831-540-5922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-30
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker