Provider Demographics
NPI:1255527461
Name:CARRILLO URBINA & GARCIA INC
Entity type:Organization
Organization Name:CARRILLO URBINA & GARCIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:909-434-0808
Mailing Address - Street 1:16980 FOOTHILL BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-3569
Mailing Address - Country:US
Mailing Address - Phone:909-434-0616
Mailing Address - Fax:
Practice Address - Street 1:16980 FOOTHILL BLVD STE E
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-3569
Practice Address - Country:US
Practice Address - Phone:909-434-0616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71133208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty