Provider Demographics
NPI:1982265799
Name:CARRILLO, JULIANE (CMT)
Entity Type:Individual
Prefix:
First Name:JULIANE
Middle Name:
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1979 BECHELLI LN
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-0133
Mailing Address - Country:US
Mailing Address - Phone:510-676-0839
Mailing Address - Fax:
Practice Address - Street 1:3609 BECHELLI LN STE E
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2453
Practice Address - Country:US
Practice Address - Phone:510-676-0839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-23
Last Update Date:2019-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71751225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist