Provider Demographics
NPI:1770937153
Name:CARRILLO, CHRISTINA
Entity type:Individual
Prefix:
First Name:CHRISTINA
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 1:5080 ANNUNCIATION CIR
Mailing Address - Street 2:#103
Mailing Address - City:AVE MARIA
Mailing Address - State:FL
Mailing Address - Zip Code:34142-9648
Mailing Address - Country:US
Mailing Address - Phone:239-357-8462
Mailing Address - Fax:888-647-1951
Practice Address - Street 1:5080 ANNUNCIATION CIR
Practice Address - Street 2:#103
Practice Address - City:AVE MARIA
Practice Address - State:FL
Practice Address - Zip Code:34142-9648
Practice Address - Country:US
Practice Address - Phone:239-357-8462
Practice Address - Fax:888-647-1951
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3659171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist