Active NPI
Patty Carrillo, RN
- Registered Nurse
- Fresno, CA
National Provider Identifier
1235978362
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 95322679
- Practice address
- 1925 E Dakota Ave
Fresno, CA 93726-4821 - Phone
- (559) 600-9180
- NPI assigned
- May 20, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 95322679 | CA | Primary |
Addresses
Primary practice location
1925 E Dakota Ave
Fresno, CA 93726-4821
Mailing address
3700 Loma Vista Pkwy Apt 2403
Clovis, CA 93619-9838
Phone (312) 375-6463
Other practice location 1
2719 N Air Fresno Dr
Fresno, CA 93727-1547
Phone (559) 600-9180
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95322679 | CA | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1716163200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1716163200000",
"number": "1235978362",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3700 LOMA VISTA PKWY APT 2403",
"city": "CLOVIS",
"state": "CA",
"postal_code": "936199838",
"telephone_number": "312-375-6463"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1925 E DAKOTA AVE",
"city": "FRESNO",
"state": "CA",
"postal_code": "937264821",
"telephone_number": "559-600-9180"
}
],
"practiceLocations": [
{
"address_1": "2719 N Air Fresno Dr",
"address_purpose": "LOCATION",
"city": "Fresno",
"state": "CA",
"postal_code": "937271547",
"country_code": "US",
"telephone_number": "559-600-9180",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CARRILLO",
"first_name": "PATTY",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-05-20",
"last_updated": "2024-05-20",
"certification_date": "2024-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Registered Nurse",
"state": "CA",
"license": "95322679",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fresno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.