Provider Demographics
NPI:1013578855
Name:CARRILLO, LAURA IRIS
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:IRIS
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3218 LERMA DR
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-4756
Mailing Address - Country:US
Mailing Address - Phone:361-562-6657
Mailing Address - Fax:
Practice Address - Street 1:4430 S MCCOLL RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-9608
Practice Address - Country:US
Practice Address - Phone:956-803-0153
Practice Address - Fax:956-803-0135
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141777363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily