Provider Demographics
NPI:1083419410
Name:CARRILLO, ZULEMA NISBET
Entity type:Individual
Prefix:
First Name:ZULEMA
Middle Name:NISBET
Last Name:CARRILLO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92231-2044
Mailing Address - Country:US
Mailing Address - Phone:760-270-9126
Mailing Address - Fax:
Practice Address - Street 1:637 GRANT ST
Practice Address - Street 2:
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-2044
Practice Address - Country:US
Practice Address - Phone:760-270-9126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker