Provider Demographics
NPI:1760648489
Name:CARRILLO, BELEN HERLINDA
Entity Type:Individual
Prefix:MS
First Name:BELEN
Middle Name:HERLINDA
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 FRENCH ST
Mailing Address - Street 2:SUITE #202
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-2475
Mailing Address - Country:US
Mailing Address - Phone:174-824-8150
Mailing Address - Fax:174-824-8151
Practice Address - Street 1:1615 FRENCH ST
Practice Address - Street 2:SUITE #202
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-2475
Practice Address - Country:US
Practice Address - Phone:714-824-8150
Practice Address - Fax:714-824-8151
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-01
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner