Provider Demographics
NPI:1104973478
Name:CARRILLO, VICTOR HUGO (DDS)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:HUGO
Last Name:CARRILLO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 H ST STE 4
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-4331
Mailing Address - Country:US
Mailing Address - Phone:619-420-2231
Mailing Address - Fax:619-420-2312
Practice Address - Street 1:401 H ST STE 4
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-4331
Practice Address - Country:US
Practice Address - Phone:619-420-2231
Practice Address - Fax:619-420-2312
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40553122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist