Provider Demographics
NPI:1669171856
Name:CARRILLO, ANGELINA
Entity type:Individual
Prefix:
First Name:ANGELINA
Middle Name:
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10981 SAN DIEGO MISSION RD STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-2448
Mailing Address - Country:US
Mailing Address - Phone:619-889-8160
Mailing Address - Fax:619-521-0867
Practice Address - Street 1:10981 SAN DIEGO MISSION RD STE 110
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-2448
Practice Address - Country:US
Practice Address - Phone:619-889-8160
Practice Address - Fax:619-521-0867
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172V00000XOther Service ProvidersCommunity Health Worker