| Doctor Name: | MR. EDGAR RICARDO CARRILLO |
| NPI Number: | 1891149142 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MPAS, PA-C |
| License Number: | PA10432 |
| Business Practice Address: | 640 S Expressway 77 Ste 2 Raymondville, TX - 785804241 |
| Business Phone Number: | 9566894120 |
| Business Fax Number: | 9566894142 |
| Mailing Address: | 2813 W Fern Ave, MCALLEN |
| State: | TX |
| Postal Code: | 785016237 |
| Phone Number: | 9562120358 |
| Fax Number: | |
| NPI Enumeration Date: | 04/22/2016 |
| NPI Last Update Date: | 04/22/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA10432 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |