Provider Demographics
NPI:1568890945
Name:CARRILLO, JAIME KAMAILE (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:KAMAILE
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:KAMAILE
Other - Last Name:KOBASHIGAWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:17321 BOSWELL PL
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-1023
Mailing Address - Country:US
Mailing Address - Phone:808-387-6906
Mailing Address - Fax:
Practice Address - Street 1:3160 E DEL MAR BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-4649
Practice Address - Country:US
Practice Address - Phone:626-270-2400
Practice Address - Fax:626-270-2498
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA689151363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily