Doctor Name: | JIMMY RAFAEL CARRILLO |
NPI Number: | 1285910778 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | PA9106175 |
Business Practice Address: | 3269 Highway 90 Bonifay, FL - 324256001 |
Business Phone Number: | 8505479991 |
Business Fax Number: | 8505479992 |
Mailing Address: | 3269 Highway 90, BONIFAY |
State: | FL |
Postal Code: | 324256001 |
Phone Number: | 8505479991 |
Fax Number: | 8505479992 |
NPI Enumeration Date: | 10/27/2011 |
NPI Last Update Date: | 10/27/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PA9106175 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |