Provider Demographics
NPI:1437206372
Name:CARRILLO, CLAUDIA M (LAC DIPOM CMT)
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:M
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:LAC DIPOM CMT
Other - Prefix:
Other - First Name:NANIE
Other - Middle Name:
Other - Last Name:CARRILLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6200 S HOPDOWN LN
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85746-5038
Mailing Address - Country:US
Mailing Address - Phone:520-979-7078
Mailing Address - Fax:
Practice Address - Street 1:330 E 16TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85701-2811
Practice Address - Country:US
Practice Address - Phone:520-979-7078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ465171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist