Provider Demographics
NPI:1831495944
Name:JARAMILLO, CARLOS EDWARD (PA-C)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:EDWARD
Last Name:JARAMILLO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:CARLOS
Other - Middle Name:EDUARDO
Other - Last Name:CANIZALES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:510-490-1222
Mailing Address - Fax:
Practice Address - Street 1:3200 KEARNEY ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2299
Practice Address - Country:US
Practice Address - Phone:510-490-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21465363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical