Provider Demographics
NPI:1518994524
Name:CARRILLO IREGUI, ADRIANA A (MD)
Entity type:Individual
Prefix:DR
First Name:ADRIANA
Middle Name:A
Last Name:CARRILLO IREGUI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3100 SW 62ND AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3009
Mailing Address - Country:US
Mailing Address - Phone:305-662-8386
Mailing Address - Fax:786-624-4151
Practice Address - Street 1:3100 SW 62ND AVE STE 102
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3009
Practice Address - Country:US
Practice Address - Phone:305-662-8368
Practice Address - Fax:786-624-4151
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME869452080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2674556-00Medicaid
FL2674556-00Medicaid
FLH94538Medicare UPIN