Basic Information
| Provider Information | |||||||||
| NPI: | 1679961825 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARRILLO | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | |||||||||
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| Credential: | INTERN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40925 COUNTY CENTER DR # 1007200 | ||||||||
| Address2: | |||||||||
| City: | TEMECULA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925916054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516006360 | ||||||||
| FaxNumber: | 9516006377 | ||||||||
| Practice Location | |||||||||
| Address1: | 40925 COUNTY CENTER DR STE 100&200 | ||||||||
| Address2: | |||||||||
| City: | TEMECULA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925916054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516006360 | ||||||||
| FaxNumber: | 9516006377 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2014 | ||||||||
| LastUpdateDate: | 03/06/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | C041400417 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.