Provider Demographics
NPI:1669534954
Name:CARRILLO, HERNANDO (MD)
Entity type:Individual
Prefix:
First Name:HERNANDO
Middle Name:
Last Name:CARRILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4331 SW 160TH AVE
Mailing Address - Street 2:APT 219
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-5722
Mailing Address - Country:US
Mailing Address - Phone:321-446-8094
Mailing Address - Fax:
Practice Address - Street 1:4331 SW 160TH AVE
Practice Address - Street 2:APT 219
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-5722
Practice Address - Country:US
Practice Address - Phone:321-446-8094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91870207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine