Provider Demographics
NPI:1477976983
Name:CARRILLO, LETICIA (MA)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3653 192ND ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-4206
Mailing Address - Country:US
Mailing Address - Phone:708-541-8159
Mailing Address - Fax:
Practice Address - Street 1:3653 192ND ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-4206
Practice Address - Country:US
Practice Address - Phone:708-541-8159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter