Provider Demographics
NPI:1043106396
Name:CARRILLO-LOERA, BEATRIZ (CMT)
Entity type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:
Last Name:CARRILLO-LOERA
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:BEATRIZ
Other - Middle Name:GUADALUPE
Other - Last Name:CARRILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3356 2ND AVE STE C
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-5636
Mailing Address - Country:US
Mailing Address - Phone:619-886-2227
Mailing Address - Fax:
Practice Address - Street 1:3356 2ND AVE STE C
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5636
Practice Address - Country:US
Practice Address - Phone:619-886-2227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-14
Last Update Date:2025-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33639225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist