Provider Demographics
NPI:1356229959
Name:CARRILLO, PABLO GALVAN
Entity type:Individual
Prefix:
First Name:PABLO
Middle Name:GALVAN
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 1:563 WALKHAM PL
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407-5823
Mailing Address - Country:US
Mailing Address - Phone:707-975-1028
Mailing Address - Fax:
Practice Address - Street 1:563 WALKHAM PL
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-5823
Practice Address - Country:US
Practice Address - Phone:707-975-1028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist