Provider Demographics
NPI:1407024102
Name:CARRILLO, JESUS ARTURO (COTA/L)
Entity Type:Individual
Prefix:MR
First Name:JESUS
Middle Name:ARTURO
Last Name:CARRILLO
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11713 SHERWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602
Mailing Address - Country:US
Mailing Address - Phone:916-532-3940
Mailing Address - Fax:
Practice Address - Street 1:6960 DESTINY DRIVE
Practice Address - Street 2:SUITE 117
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-2993
Practice Address - Country:US
Practice Address - Phone:916-532-3940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA548224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant