Provider Demographics
NPI:1417408675
Name:CARRILLO, ALVARO
Entity Type:Individual
Prefix:
First Name:ALVARO
Middle Name:
Last Name:CARRILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5409 GOLDBRUSH ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-1678
Mailing Address - Country:US
Mailing Address - Phone:702-287-9127
Mailing Address - Fax:702-570-5200
Practice Address - Street 1:5409 GOLDBRUSH ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-1678
Practice Address - Country:US
Practice Address - Phone:702-287-9127
Practice Address - Fax:702-570-5200
Is Sole Proprietor?:No
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1604211634OtherMEDICAID