Doctor Name: | JAVIER CARRILLO |
NPI Number: | 1427417468 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 770391 |
Business Practice Address: | 2240 Winrow Ave Usa Meddac, Rwbahc Fort Huachuca, AZ - 85613 |
Business Phone Number: | 5205337568 |
Business Fax Number: | |
Mailing Address: | 2240 Winrow Ave, Usa Meddac, Rwbahc FORT HUACHUCA |
State: | AZ |
Postal Code: | 85613 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 02/18/2016 |
NPI Last Update Date: | 02/18/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 163WP2201X |
License Number: | 770391 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Registered Nurse |
Taxonomy Specialization: | Ambulatory Care |
Taxonomy Definition: |