Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Carrie M Carrillo, PA

Individual provider Surgical Physician Assistant · NPI 1588872089

Carrie M Carrillo, PA is a Physician Assistant in Fullerton, California. Qualified in 2004, 22 years ago. Practices with Providence Medical Foundation, a 1,465-clinician group and accepts Medicare assignment. Licensed in California.

Years since qualifying
22
Licensed in
CA
In the registry since
2007
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

2141 N Harbor Blvd Ste 35000
Fullerton, CA 92835-3831
Phone: (714) 626-8630
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence PA17561 (CA)

Record details

NPI number1588872089
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedMay 18, 2007
Last updated in NPPESOctober 20, 2021
Certification dateOctober 20, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2004 (22 years in practice)
Group practice Providence Medical Foundation — 1465 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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