Provider Demographics
NPI:1508526476
Name:CARRILLO, ELSA E (RDN)
Entity Type:Individual
Prefix:
First Name:ELSA
Middle Name:E
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W KAVILAND AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706-4723
Mailing Address - Country:US
Mailing Address - Phone:424-264-8461
Mailing Address - Fax:
Practice Address - Street 1:2042 KERN ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-2008
Practice Address - Country:US
Practice Address - Phone:559-400-6420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-20
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered