Juan C Carrillo, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

G57429 Issued in CA

Practice address

2880 Story Rd
San Jose, CA 95127-3942

Phone

(408) 929-5439

Fax

(408) 929-5010

NPI assigned

Jul 20, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Juan C Carrillo MD a Professional Corporation

  • Primary Care Clinic/Center
  • San Jose, CA
  • NPI 1740793090
  NPD (past) Authorized official
• Cervantes Medical Corporation

  • Family Medicine Physician
  • San Jose, CA
  • NPI 1417768011
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1124048301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2880 STORY RD",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "95127",
            "telephone_number": "408-929-5439",
            "fax_number": "408-929-5010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2880 STORY RD",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951273942",
            "telephone_number": "408-929-5439",
            "fax_number": "408-929-5010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARRILLO",
        "first_name": "JUAN",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-20",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "G57429",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL PROVIDER #",
            "identifier": "00G574290",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexia Karina Carrillo Sanchez, SPEECH LANGUAGE PATH
• Blanca Alicia Carrillo-Serrano, A.S.W.
• Christian Jose Antonio Carrillo
• Dianna Carrillo
• Jennifer Carrillo
• Maria Carrillo
• Oscar Carrillo
• Regina Carrillo
• Samantha Carrillo
• Sophia Alexandra Carrillo

• Pediatrics Physician in San Jose, CA
• Providers in San Jose, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.