CARRIE M CARRILLO (NPI# 1588872089) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588872089 |
| Entity Type | Individual |
| Full Name | CARRIE M CARRILLO |
| Credential | PA |
| Practice Address |
2141 N Harbor Blvd Ste 35000 Fullerton CA 92835-3831 |
| Practice Telephone | 7146268630 |
| Mailing Telephone | 7146268630 |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2020-10-19 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
PA17561 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | LICENSE | PA17561 | 01 |
| Street Address |
2141 N HARBOR BLVD STE 35000 |
| City | FULLERTON |
| State | CA |
| Zip Code | 92835-3831 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366442998 | Andrew Concoff | Internal Medicine | 2141 N Harbor Blvd Ste 35000, Fullerton, CA 92835-3831 | 2005-07-26 |
| 1013487883 | Austin James Perkins | Physician Assistant | 2141 N Harbor Blvd Ste 35000, Fullerton, CA 92835-3831 | 2018-12-04 |
| 1346716842 | Charles Alexandre Greener | Physician Assistant | 2141 N Harbor Blvd Ste 35000, Fullerton, CA 92835-3831 | 2018-10-23 |
| 1265946610 | Kate S. Boulder | Nurse Practitioner | 2141 N Harbor Blvd Ste 35000, Fullerton, CA 92835-3831 | 2017-11-21 |
| 1962787838 | Julie B Hastin | Physician Assistant | 2141 N Harbor Blvd Ste 35000, Fullerton, CA 92835-3831 | 2011-10-11 |
| 1316243769 | St Joseph Heritage Healthcare | Durable Medical Equipment & Medical Supplies | 2141 N Harbor Blvd Ste 35000, Fullerton, CA 92835 | 2011-02-02 |
| 1972726784 | Kyla Ama Davis | Physician Assistant | 2141 N Harbor Blvd Ste 35000, Fullerton, CA 92835-3831 | 2007-04-10 |
| 1760554232 | Kevin Kinzinger | Specialist | 2141 N Harbor Blvd Ste 35000, Fullerton, CA 92835-3831 | 2006-11-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538774302 | Natalie Baugh | Nutritionist | 333 W Bastanchury Rd 110, Fullerton, CA 92835 | 2020-09-09 |
| 1073127098 | Cecile Mae Sam | Physical Therapist | 2932 Clover Ct, Fullerton, CA 92835 | 2020-09-08 |
| 1861966087 | Kimson F Johnston | Marriage & Family Therapist | 1370 Brea Blvd Suite 210, Fullerton, CA 92835 | 2019-01-22 |
| 1134636327 | Michelle Harriman, Psychologist - A Professional Corporation | Psychologist | 1440 N Harbor Blvd Ste 808, Fullerton, CA 92835 | 2018-01-09 |
| 1659818631 | Jacqueline Rene Miller | Specialist/Technologist | 2610 Associated Rd, Apt A4, Fullerton, CA 92835 | 2017-01-27 |
| 1912361106 | John Nathaniel Alvarez | Psychiatry & Neurology | 401 E Imperial Highway, Fullerton, CA 92835 | 2016-04-13 |
| 1083075030 | Advance Recovery Solution, LLC | Substance Abuse Rehabilitation Facility | 3744 N Hermosa Pl, Fullerton, CA 92835 | 2016-03-17 |
| 1467817981 | Michele Ledesma | Physical Therapy Assistant | 2800 N. Harbor Blvd., Fullerton, CA 92835 | 2015-12-29 |
| 1467820571 | Jonghan Kang | Acupuncturist | 1321 N Harbor Blvd Ste 205, Fullerton, CA 92835 | 2015-09-04 |
| 1265840987 | Allison Leigh Kennedy | Physician Assistant | 100 Laguna Rd Ste 208, Fullerton, CA 92835 | 2014-07-25 |
| Find all providers in zip 92835 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861581563 | Roger William Skebelsky | Physician Assistant | 100 E Valencia Mesa Drive, 310, Fullerton, CA 92835 | 2006-10-12 |
| 1013487883 | Austin James Perkins | Physician Assistant | 2141 N Harbor Blvd Ste 35000, Fullerton, CA 92835-3831 | 2018-12-04 |
| 1346716842 | Charles Alexandre Greener | Physician Assistant | 2141 N Harbor Blvd Ste 35000, Fullerton, CA 92835-3831 | 2018-10-23 |
| 1558897413 | Marie Katherine Mulcock | Physician Assistant | 801 E Chapman Ave Ste 203, Fullerton, CA 92831-3846 | 2017-05-11 |
| 1952589459 | May Majied Ali | Physician Assistant | 100 E Valencia Mesa Dr, Suite 311, Fullerton, CA 92835-3813 | 2008-02-06 |
| 1275742462 | Carrie-anne Clark | Physician Assistant | 100 E Valencia Mesa Dr, Suite 105, Fullerton, CA 92835-3813 | 2007-05-22 |
| 1174731640 | Dennis Wayne Briley | Physician Assistant | 100 E Valencia Mesa Dr, Suite 105, Fullerton, CA 92835-3813 | 2007-05-18 |
| 1205889326 | William Charles Andrew Hall | Physician Assistant | 2141 N Harbor Blvd, Suite 35000, Fullerton, CA 92835 | 2006-05-18 |
| 1912961038 | Grace Jin Lee | Physician Assistant | 1950 Sunnycrest Dr, Suite 2600, Fullerton, CA 92835-3638 | 2006-04-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649894403 | Kathlyn Larco | Physician Assistant | 1233 W Randall Way, West Covina, CA 91790-4747 | 2020-06-07 |
| 1487126421 | Eliza Hughes | Physician Assistant | 860 Oak Park Blvd Ste 101, Arroyo Grande, CA 93420-1800 | 2018-12-31 |
| 1508333873 | Andrew Cantos Malit | Physician Assistant | 409 Bristol Way, Corona, CA 92879-6156 | 2018-10-25 |
| 1578049458 | Ida Jelveh | Physician Assistant | 28096 Edelweiss Ct, Laguna Niguel, CA 92677-7006 | 2018-07-13 |
| 1356833578 | Michael James Gonzalez | Physician Assistant | 1500 E Chevy Chase Dr # 401a401b, Glendale, CA 91206-4152 | 2018-06-04 |
| 1023500592 | Pamela Lambert Pa-c, Inc. | Physician Assistant | 16105 Mariposa Ave, Riverside, CA 92504-8730 | 2018-05-31 |
| 1225532385 | Folsom Physicain Assistant First Assist, Inc | Physician Assistant | Nina Vasiliev Pa-c, 15407 Muller Rd, Plymouth, CA 95669-9770 | 2018-03-22 |
| 1275040008 | Gm Surgical Assistant Inc | Physician Assistant | 15615 Turnberry St, Moreno Valley, CA 92555-4901 | 2018-01-02 |
| 1902311186 | Or Solutions Inc | Physician Assistant | 1501 Secret Ravine Pkwy Unit 527, Roseville, CA 95661-6005 | 2017-12-09 |
| 1184143828 | Alaa Abdalla Daghlas | Physician Assistant | 1100 S Eliseo Dr Ste A, Greenbrae, CA 94904-2017 | 2017-09-13 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.