Provider Demographics
NPI:1477322881
Name:CARRILLO, ELBA VIRGINIA
Entity Type:Individual
Prefix:MS
First Name:ELBA
Middle Name:VIRGINIA
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:VICKY
Other - Middle Name:VIRGINIA
Other - Last Name:CARRILLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2505 BERING DR UNIT 3
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-4915
Mailing Address - Country:US
Mailing Address - Phone:832-623-8644
Mailing Address - Fax:
Practice Address - Street 1:2505 BERING DR UNIT 3
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-4915
Practice Address - Country:US
Practice Address - Phone:832-623-8644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist