Provider Demographics
NPI:1689878571
Name:CARRILLO, AURA L (MD)
Entity Type:Individual
Prefix:
First Name:AURA
Middle Name:L
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9905 NW 9TH STREET CIR APT 3
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-5145
Mailing Address - Country:US
Mailing Address - Phone:305-552-1278
Mailing Address - Fax:
Practice Address - Street 1:8390 W FLAGLER ST
Practice Address - Street 2:SUITE 221
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2039
Practice Address - Country:US
Practice Address - Phone:305-226-5574
Practice Address - Fax:305-221-9066
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0071819207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG40233Medicare UPIN
FL32344XMedicare ID - Type UnspecifiedMEDICARE