Provider Demographics
NPI:1104851781
Name:CARRILLO, ZULMA (DO)
Entity type:Individual
Prefix:MRS
First Name:ZULMA
Middle Name:
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8056
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-8056
Mailing Address - Country:US
Mailing Address - Phone:787-309-3412
Mailing Address - Fax:787-739-8190
Practice Address - Street 1:CALLE FRANCISCO HADDOCK 1330
Practice Address - Street 2:
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739
Practice Address - Country:US
Practice Address - Phone:787-739-8182
Practice Address - Fax:787-739-8120
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2533103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical