Provider Demographics
NPI:1801042437
Name:LOPEZ-CARRILLO, RAIDEN (CRNA)
Entity Type:Individual
Prefix:
First Name:RAIDEN
Middle Name:
Last Name:LOPEZ-CARRILLO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7660 SW 134TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-3325
Mailing Address - Country:US
Mailing Address - Phone:305-728-9949
Mailing Address - Fax:
Practice Address - Street 1:7660 SW 134TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-3325
Practice Address - Country:US
Practice Address - Phone:305-728-9949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9418218367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered