Provider Demographics
NPI:1861123036
Name:CARRILLO, DAVID E (LVN)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:CARRILLO
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 1/2 E 55TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90011-5352
Mailing Address - Country:US
Mailing Address - Phone:323-891-0990
Mailing Address - Fax:
Practice Address - Street 1:936 1/2 E 55TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011-5352
Practice Address - Country:US
Practice Address - Phone:323-891-0990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA710485164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse