Provider Demographics
NPI:1851153944
Name:CARRILLO SANABRIA, DISNEY
Entity Type:Individual
Prefix:
First Name:DISNEY
Middle Name:
Last Name:CARRILLO SANABRIA
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 1:8830 BRENNAN CIR APT 303
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-6205
Mailing Address - Country:US
Mailing Address - Phone:786-303-2878
Mailing Address - Fax:
Practice Address - Street 1:8830 BRENNAN CIR APT 303
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-6205
Practice Address - Country:US
Practice Address - Phone:786-303-2878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-318645106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician