Provider Demographics
NPI:1578528717
Name:CARRILLO, YSELA M (MD)
Entity Type:Individual
Prefix:DR
First Name:YSELA
Middle Name:M
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 EDWARD CURD LN
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-5662
Mailing Address - Country:US
Mailing Address - Phone:615-791-7355
Mailing Address - Fax:615-791-7383
Practice Address - Street 1:2105 EDWARD CURD LN
Practice Address - Street 2:SUITE 102
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-5662
Practice Address - Country:US
Practice Address - Phone:615-791-7355
Practice Address - Fax:615-791-7383
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD34228208600000X
COCDR.0001584208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3855712Medicaid
TN3855712Medicare ID - Type Unspecified
TN3855712Medicaid