Basic Information
Provider Information
NPI: 1861487506
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ZORRILLA
FirstName: JUAN
MiddleName: CARLOS
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5050 AVENIDA ENCINAS
Address2: SUITE 200
City: CARLSBAD
State: CA
PostalCode: 920084383
CountryCode: US
TelephoneNumber: 7604391963
FaxNumber: 7602680931
Practice Location
Address1: 4002 VISTA WAY
Address2:  
City: OCEANSIDE
State: CA
PostalCode: 920564506
CountryCode: US
TelephoneNumber: 7609403505
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/20/2005
LastUpdateDate: 07/15/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000XA67404CAY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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