Provider Demographics
NPI:1437922929
Name:CARRILLO, JORGE C
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:C
Last Name:CARRILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PALMAS DEL MAR
Mailing Address - Street 2:FLAMBOYAN GREENS 19
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791
Mailing Address - Country:US
Mailing Address - Phone:787-616-6603
Mailing Address - Fax:
Practice Address - Street 1:PALMAS DEL MAR
Practice Address - Street 2:FLAMBOYAN GREENS 19
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-616-6603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program