Timothy Joseph Carrillo, RAS-C1106011523

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

C1106011523 Issued in CA

Practice address

504 W Vista Way
Vista, CA 92083-5704

Phone

(760) 940-1836

Fax

(760) 940-1274

NPI assigned

Oct 18, 2012

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Mental Health Systems, Inc.

  • Community/Behavioral Health Agency
  • Vista, CA
  • NPI 1821126897
  NPD (past)

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

{
    "created_epoch": "1350518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350518400000",
    "number": "1134472897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 W VISTA WAY",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920835704",
            "telephone_number": "760-940-1836",
            "fax_number": "760-940-1274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 W VISTA WAY",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920835704",
            "telephone_number": "760-940-1836",
            "fax_number": "760-940-1274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARRILLO",
        "first_name": "TIMOTHY",
        "middle_name": "JOSEPH",
        "credential": "RAS-C1106011523",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-10-18",
        "last_updated": "2012-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "C1106011523",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carlsbad and Vista Dermatology, Inc.
• Douglas M Carlsen, DDS
• Kevin Christopher Carney, PT-A
• Zachary Desmond Carpenter
• Sofia Carrillo
• Kelsey Carrio, M.D.
• Amy Sue Carter, CADC-II
• Christine Carter, RADT
• Tony Vincent Cascioppo
• Anita Casias

• All providers in Vista, CA
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.