Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | P3128 | TX |
N | 2080P0203X | Pediatric Critical Care Doctor | MD2015-0151 | NM |
Y | 2080P0203X | Pediatric Critical Care Doctor | P3128 | TX |
NPI | 1164658084 |
---|---|
Provider Name | Dr. Sabrina Carrillo |
First Address | San Antonio, TX 78229-3901 |
Second Address | San Antonio, TX 78229-4402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2009 |
Last Update Date | 22/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
372656401 | (05) | TX |
372656402 | CSHCN (01) | TX |