Active NPI
Bryant Carrillo
- Dentist
- Sacramento, CA
National Provider Identifier
1255578050
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 58020
- Practice address
- 8890 Cal Center Dive
Sacramento, CA 95826 - Phone
- (916) 922-5000
- Fax
- (916) 646-9000
- NPI assigned
- Jan 15, 2009
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 58020 | CA | Primary |
Addresses
Primary practice location
8890 Cal Center Dive
Sacramento, CA 95826
Mailing address
8890 Cal Center Dive
Sacramento, CA 95826
Phone (916) 922-5000
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 58020 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1231977600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1231977600000",
"number": "1255578050",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8890 CAL CENTER DIVE",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "95826",
"telephone_number": "916-922-5000",
"fax_number": "916-646-9000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8890 CAL CENTER DIVE",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "95826",
"telephone_number": "916-922-5000",
"fax_number": "916-646-9000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARRILLO",
"first_name": "BRYANT",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-01-15",
"last_updated": "2009-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "58020",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.