| Organization Name: | HERMAN CARRILLO MD |
| NPI Number: | 1528348901 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | HERMAN CARRILLO (PRESIDENT) |
| Mailing Address: | 14342 Ramona Blvd Baldwin Park |
| State: | CA US |
| Postal Code: | 917063241 |
| Phone Number: | 6263384088 |
| Fax Number: | 6268149068 |
| NPI Enumeration Date: | 08/17/2011 |
| NPI Last Update Date: | 08/17/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | A45086 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |