Provider Demographics
NPI:1821783861
Name:CARRILLO FLORES, ZAIDE ALEXA (RBT)
Entity Type:Individual
Prefix:MISS
First Name:ZAIDE
Middle Name:ALEXA
Last Name:CARRILLO FLORES
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:MISS
Other - First Name:ZAIDE
Other - Middle Name:ALEXA
Other - Last Name:CARRILLO FLORES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:14235 BLANCO RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-7718
Mailing Address - Country:US
Mailing Address - Phone:210-415-9626
Mailing Address - Fax:
Practice Address - Street 1:14235 BLANCO RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-7718
Practice Address - Country:US
Practice Address - Phone:210-415-9626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician