Lesley Vanessa Carrillo, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

107920 Issued in CA

Practice address

2975 Zoe Ave
Huntington Park, CA 90255-5278

Phone

(323) 826-9449

NPI assigned

Jun 28, 2022

Last updated

Sep 2, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Tri-State Community Healthcare Center

  • Federally Qualified Health Center (FQHC)
  • Needles, CA
  • NPI 1922356369
  Medicare reassignment NPD
• Tri-State Community Healthcare Center

  • Federally Qualified Health Center (FQHC)
  • Adelanto, CA
  • NPI 1508379017
  NPD
• Tri-State Community Healthcare Center

  • Federally Qualified Health Center (FQHC)
  • Laughlin, NV
  • NPI 1174125892
  NPD

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

{
    "created_epoch": "1656374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662076800000",
    "number": "1225760358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2550 W MAIN ST STE 301",
            "city": "ALHAMBRA",
            "state": "CA",
            "postal_code": "918017003",
            "telephone_number": "626-457-6900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2975 ZOE AVE",
            "city": "HUNTINGTON PARK",
            "state": "CA",
            "postal_code": "902555278",
            "telephone_number": "323-826-9449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARRILLO",
        "first_name": "LESLEY",
        "middle_name": "VANESSA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-28",
        "last_updated": "2022-09-02",
        "certification_date": "2022-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "107920",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victoria Carretero
• Alexandra Grace Carrillo, ACSW
• Bernardo Jose Carrillo, P.A.
• Daniel Carrillo, PHARMD.
• Ernestina Carrillo
• Antwon Carter
• Marcel Carter
• Linsey L Caruso, ASW 19803
• Maria Casiano Perez
• Alfonso Ovidio Casta Sr., MH

• General Practice Dentistry in Huntington Park, CA
• Providers in Huntington Park, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2022; 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.