Provider Demographics
NPI:1427526854
Name:CARRILLO, RALPH (DPT)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:
Last Name:CARRILLO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 SONOMA AVE
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-1402
Mailing Address - Country:US
Mailing Address - Phone:559-824-9546
Mailing Address - Fax:
Practice Address - Street 1:18 SONOMA AVE
Practice Address - Street 2:
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93117-1402
Practice Address - Country:US
Practice Address - Phone:559-824-9546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-03
Last Update Date:2018-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT29125225100000X
PT29125225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty