Provider Demographics
NPI:1154461515
Name:CARRILLO, MICHELLE (MA)
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 PEDLEY RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92509-3966
Mailing Address - Country:US
Mailing Address - Phone:951-360-4191
Mailing Address - Fax:
Practice Address - Street 1:10000 COUNTY FARM RD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3508
Practice Address - Country:US
Practice Address - Phone:951-358-4390
Practice Address - Fax:951-358-4472
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health