Provider Demographics
NPI:1659720811
Name:IGNACIO M CARRILLO NUNEZ MD PC
Entity Type:Organization
Organization Name:IGNACIO M CARRILLO NUNEZ MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IGNACIO
Authorized Official - Middle Name:MARCOS
Authorized Official - Last Name:CARRILLO-NUNEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-797-9027
Mailing Address - Street 1:18111 BROOKHURST ST
Mailing Address - Street 2:SUITE 6200
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6728
Mailing Address - Country:US
Mailing Address - Phone:714-797-9027
Mailing Address - Fax:714-378-5517
Practice Address - Street 1:18111 BROOKHURST ST
Practice Address - Street 2:SUITE 6200
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6728
Practice Address - Country:US
Practice Address - Phone:714-797-9027
Practice Address - Fax:714-378-5517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0510492084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular NeurologyGroup - Single Specialty