Provider Demographics
NPI:1942854377
Name:CARRILLO CUEVAS, JATSIRI
Entity Type:Individual
Prefix:
First Name:JATSIRI
Middle Name:
Last Name:CARRILLO CUEVAS
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:PO BOX 1485
Mailing Address - Street 2:
Mailing Address - City:SUMMERLAND
Mailing Address - State:CA
Mailing Address - Zip Code:93067-1485
Mailing Address - Country:US
Mailing Address - Phone:805-280-9306
Mailing Address - Fax:
Practice Address - Street 1:1911 WILLIAMS DR STE 200
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-0673
Practice Address - Country:US
Practice Address - Phone:805-981-6830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health