Provider Demographics
NPI:1558082537
Name:FLORES CARRILLO, EDUARDO ALBERTO CHRISTOPHER
Entity Type:Individual
Prefix:
First Name:EDUARDO ALBERTO
Middle Name:CHRISTOPHER
Last Name:FLORES 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:BEHAVIOR FRONTIERS, LLC
Mailing Address - Street 2:3255 OLD CONEJO RD, SUITE 202
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320
Mailing Address - Country:US
Mailing Address - Phone:805-254-6249
Mailing Address - Fax:855-568-2494
Practice Address - Street 1:BEHAVIOR FRONTIERS, LLC
Practice Address - Street 2:3255 OLD CONEJO RD, SUITE 202
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320
Practice Address - Country:US
Practice Address - Phone:805-254-6249
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician