Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003413618 |
---|---|
Provider Name | Eylis Carrillo |
First Address | Santa Maria, CA 93455-6819 |
Second Address | Fresno, CA 93727-1624 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2020 |
Last Update Date | 06/10/2020 |