Provider Demographics
NPI:1851159743
Name:CARRILLO, LUCRECIA (CASE MANAGER)
Entity Type:Individual
Prefix:
First Name:LUCRECIA
Middle Name:
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PINE CONE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:NV
Mailing Address - Zip Code:89403-6309
Mailing Address - Country:US
Mailing Address - Phone:775-246-6326
Mailing Address - Fax:775-246-6312
Practice Address - Street 1:5 PINE CONE RD STE 103
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:NV
Practice Address - Zip Code:89403-6309
Practice Address - Country:US
Practice Address - Phone:775-246-6326
Practice Address - Fax:775-246-6312
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator