Provider Demographics
NPI:1891149142
Name:CARRILLO, EDGAR RICARDO (MPAS, PA-C)
Entity Type:Individual
Prefix:MR
First Name:EDGAR
Middle Name:RICARDO
Last Name:CARRILLO
Suffix:
Gender:M
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:2813 W FERN AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-6237
Mailing Address - Country:US
Mailing Address - Phone:956-212-0358
Mailing Address - Fax:
Practice Address - Street 1:640 S EXPRESSWAY 77 STE 2
Practice Address - Street 2:
Practice Address - City:RAYMONDVILLE
Practice Address - State:TX
Practice Address - Zip Code:78580-4241
Practice Address - Country:US
Practice Address - Phone:956-689-4120
Practice Address - Fax:956-689-4142
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10432363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical