Lina Michelle Carrillo-Fulk, RN, PHN

Primary specialty

Community Health Registered NurseTaxonomy code 163WC1500X

License

257962 Issued in CA

Practice address

308 East San Jacinto Avenue
Perris, CA 92570

Phone

(951) 210-1349

NPI assigned

Dec 4, 2007

Sex

Female

Sole proprietor

No

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

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1196726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196726400000",
    "number": "1457533291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4065 COUNTY CIRCLE DR",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925033410",
            "telephone_number": "951-210-1349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 EAST SAN JACINTO AVENUE",
            "city": "PERRIS",
            "state": "CA",
            "postal_code": "92570",
            "telephone_number": "951-210-1349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARRILLO-FULK",
        "first_name": "LINA",
        "middle_name": "MICHELLE",
        "credential": "RN, PHN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-12-04",
        "last_updated": "2007-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC1500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Community Health",
            "state": "CA",
            "license": "257962",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community Health Registered Nurse in Perris, CA
• Providers in Perris, CA by specialty
• Community Health Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2007; 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.