Provider Demographics
NPI:1528649282
Name:CARRILLO, JAIME (MD)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:CARRILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:ORLANDO
Other - Last Name:CARRILLO-MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3901 MONTGOMERY BLVD NE APT 306
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1086
Mailing Address - Country:US
Mailing Address - Phone:832-410-5507
Mailing Address - Fax:
Practice Address - Street 1:1401 MADISON ST STE 100
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-1316
Practice Address - Country:US
Practice Address - Phone:206-386-6054
Practice Address - Fax:206-215-6027
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program