Provider Demographics
NPI:1679389266
Name:CARRILLO, ALEXIS RICARDO
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:RICARDO
Last Name:CARRILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 ELKHORN BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH HIGHLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:95660-3503
Mailing Address - Country:US
Mailing Address - Phone:916-367-2291
Mailing Address - Fax:
Practice Address - Street 1:4110 ELKHORN BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HIGHLANDS
Practice Address - State:CA
Practice Address - Zip Code:95660-3503
Practice Address - Country:US
Practice Address - Phone:916-367-2291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion