Provider Demographics
NPI:1942980206
Name:CARRILLO, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:CARRILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7006 S HOOVER ST APT 14
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-5292
Mailing Address - Country:US
Mailing Address - Phone:323-616-4247
Mailing Address - Fax:
Practice Address - Street 1:17037 CHATSWORTH ST STE 102
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-5881
Practice Address - Country:US
Practice Address - Phone:326-616-4247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator