Provider Demographics
NPI:1780912014
Name:CARRILLO, ZULEMA (PA-C)
Entity type:Individual
Prefix:MISS
First Name:ZULEMA
Middle Name:
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-1474
Mailing Address - Country:US
Mailing Address - Phone:951-652-0090
Mailing Address - Fax:951-652-0090
Practice Address - Street 1:1003 N STATE ST
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-1474
Practice Address - Country:US
Practice Address - Phone:951-652-0090
Practice Address - Fax:951-652-0090
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20717363AM0700X
PA20717363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant