Provider Demographics
NPI:1336107218
Name:CARRILLO, SENECA AKASHA (MD)
Entity Type:Individual
Prefix:DR
First Name:SENECA
Middle Name:AKASHA
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SENECA
Other - Middle Name:AKASHA
Other - Last Name:MESSMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1740 E PURDUE AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020
Mailing Address - Country:US
Mailing Address - Phone:602-405-0801
Mailing Address - Fax:
Practice Address - Street 1:5102 W CAMPBELL AVE
Practice Address - Street 2:MARYVALE HOSPITAL
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031
Practice Address - Country:US
Practice Address - Phone:623-848-5000
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31008207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3981220OtherEVERCARE GRP
AZ783721Medicaid
AZAW1436OtherHEALTHNET GRP
AZAZ0728670OtherBLUE CROSS BLUE SHIELD GR
AZ104575Medicare ID - Type Unspecified
AZ783721Medicaid