Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1043559313 |
---|---|
Provider Name | Mrs. Ines Carrillo |
First Address | Canoga Park, CA 91303-4255 |
Second Address | Canoga Park, CA 91303-4255 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2013 |
Last Update Date | 06/02/2013 |