Provider Demographics
NPI:1265140479
Name:CARRENO, SYLVIA JOHANNA (BA)
Entity type:Individual
Prefix:
First Name:SYLVIA
Middle Name:JOHANNA
Last Name:CARRENO
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4148 LAKE PARK LN
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-7886
Mailing Address - Country:US
Mailing Address - Phone:760-672-3222
Mailing Address - Fax:
Practice Address - Street 1:4148 LAKE PARK LN
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-7886
Practice Address - Country:US
Practice Address - Phone:760-672-3222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician