| Doctor Name: | MR. BERNARDO JOSE CARRILLO |
| NPI Number: | 1063518611 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | P.A. |
| License Number: | PA14716 |
| Business Practice Address: | 2550 W Main St Suite 301 Alhambra, CA - 918011694 |
| Business Phone Number: | 6264576900 |
| Business Fax Number: | 6264576902 |
| Mailing Address: | Po Box 2203, DOWNEY |
| State: | CA |
| Postal Code: | 902420203 |
| Phone Number: | 5629232502 |
| Fax Number: | |
| NPI Enumeration Date: | 09/14/2006 |
| NPI Last Update Date: | 05/14/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA14716 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |