Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225400000X | Rehabilitation Practitioner |
NPI | 1023637139 |
---|---|
Provider Name | Peter Ernest Carrillo |
First Address | Van Nuys, CA 91406 |
Second Address | Van Nuys, CA 91406-3345 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2020 |
Last Update Date | 02/09/2020 |