Provider Demographics
NPI:1134901184
Name:CARRILLO, MARIA ISABEL (MA, CHW)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:ISABEL
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:MA, CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 S LONG BEACH BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90221-3491
Mailing Address - Country:US
Mailing Address - Phone:323-774-6551
Mailing Address - Fax:323-760-9664
Practice Address - Street 1:403 S LONG BEACH BLVD STE B
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-3491
Practice Address - Country:US
Practice Address - Phone:323-774-6551
Practice Address - Fax:323-760-9664
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker