Provider Demographics
NPI:1689997504
Name:CARRILLO, ESMERALDA N
Entity Type:Individual
Prefix:
First Name:ESMERALDA
Middle Name:N
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 1:201 NORTH 'K' STREET
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274
Mailing Address - Country:US
Mailing Address - Phone:559-687-0929
Mailing Address - Fax:559-685-8953
Practice Address - Street 1:201 NORTH 'K' STREET
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274
Practice Address - Country:US
Practice Address - Phone:559-687-0929
Practice Address - Fax:559-685-8953
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-05
Last Update Date:2019-09-30
Deactivation Date:2019-09-10
Deactivation Code:
Reactivation Date:2019-09-30
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor