Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 52674 | TN |
N | 2080P0208X | Pediatric Infectious Diseases | 7715 | SD |
NPI | 1467774844 |
---|---|
Provider Name | Maria Alejandra Carrillo-Marquez |
First Address | Sioux Falls, SD 57117-5074 |
Second Address | Memphis, TN 38105-4625 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2010 |
Last Update Date | 17/03/2018 |