Provider Demographics
NPI:1841788668
Name:CARRILLO, ANGELICA E (PUBLIC HEALTH NURSE)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:E
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:PUBLIC HEALTH NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 AERO JET AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-2803
Mailing Address - Country:US
Mailing Address - Phone:626-563-3953
Mailing Address - Fax:
Practice Address - Street 1:3400 AERO JET AVE STE 600
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2803
Practice Address - Country:US
Practice Address - Phone:626-569-3953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA626510163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty