Provider Demographics
NPI:1598531733
Name:CARRILLO, LITZULY (RDN, LD)
Entity Type:Individual
Prefix:
First Name:LITZULY
Middle Name:
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 SUGAR HILL DR
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:NV
Mailing Address - Zip Code:89433-8331
Mailing Address - Country:US
Mailing Address - Phone:775-685-6295
Mailing Address - Fax:
Practice Address - Street 1:4001 S VIRGINIA ST STE F
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-6029
Practice Address - Country:US
Practice Address - Phone:775-284-1898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-29
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV40778-DI-0133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered