Provider Demographics
NPI:1790261824
Name:CARRILLO, DIANA (CBCS)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:CBCS
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 59
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79940-0059
Mailing Address - Country:US
Mailing Address - Phone:915-259-5288
Mailing Address - Fax:
Practice Address - Street 1:4920 VISTA GRANDE CIR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79922-1737
Practice Address - Country:US
Practice Address - Phone:915-259-5286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2018-08-20
Deactivation Date:2018-07-18
Deactivation Code:
Reactivation Date:2018-08-20
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No171W00000XOther Service ProvidersContractor
No246YC3302XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health InformationCoding Specialist, Physician Office Based