Provider Demographics
NPI:1477373884
Name:CARRILLO, CRISTHINA VANESSA (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:CRISTHINA
Middle Name:VANESSA
Last Name:CARRILLO
Suffix:
Gender:
Credentials:REGISTERED NURSE
Other - Prefix:MISS
Other - First Name:CRISTHINA
Other - Middle Name:VANESSA
Other - Last Name:CARRILLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:12440 IMPERIAL HWY STE 770
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-3177
Mailing Address - Country:US
Mailing Address - Phone:323-351-0138
Mailing Address - Fax:
Practice Address - Street 1:12440 IMPERIAL HWY STE 770
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-3177
Practice Address - Country:US
Practice Address - Phone:323-351-0138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-11
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95144153163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse