IndividualActive
Matthew Carrillo, OWNER
NPI 1356386288 · Prosthetics Case Management · Laurel, MS
Provider details
- NPI number
- 1356386288
- Entity type
- Individual
- Primary specialty
- Prosthetics Case ManagementOther Service Providers
- Credential
- OWNER
- Sex
- Male
- Sole proprietor
- Yes
- License
- 07014/11.1 (MS)
Specialties & taxonomies
Other Service Providers
Practice location
434 S 13th Ave
Laurel, MS 39440-4345
Phone: (601) 649-0001
Fax: (601) 649-0035
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 6501
Laurel, MS 39441-6501
Registry dates
- Enumerated
- 2006-06-17
- Last updated
- 2007-11-07
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.