Provider Demographics
NPI:1679231757
Name:CARRILLO, LUCIA
Entity Type:Individual
Prefix:
First Name:LUCIA
Middle Name:
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1424
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-1424
Mailing Address - Country:US
Mailing Address - Phone:707-456-9020
Mailing Address - Fax:707-456-9020
Practice Address - Street 1:286 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:WILLITS
Practice Address - State:CA
Practice Address - Zip Code:95490-3435
Practice Address - Country:US
Practice Address - Phone:707-456-9020
Practice Address - Fax:707-456-9020
Is Sole Proprietor?:No
Enumeration Date:2021-12-06
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker