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1134472897
TIMOTHY JOSEPH CARRILLO
VISTA, CA
NPI
1134472897
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: CA C1106011523)
Enumeration Date
2012-10-18
Last Update Date
2012-10-18
Business Address
-- TIMOTHY JOSEPH CARRILLO RAS-C1106011523
504 W VISTA WAY
VISTA, CA 92083-5704
Phone number: 760-940-1836
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Mailing Address
-- TIMOTHY JOSEPH CARRILLO RAS-C1106011523
504 W VISTA WAY
VISTA, CA 92083-5704
Phone number: 760-940-1836
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