Provider Demographics
NPI:1356892020
Name:CARRILLO, ESTEBAN JR (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ESTEBAN
Middle Name:
Last Name:CARRILLO
Suffix:JR
Gender:M
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3612 PERA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-2412
Mailing Address - Country:US
Mailing Address - Phone:915-533-7057
Mailing Address - Fax:915-440-2919
Practice Address - Street 1:3607 RIVERA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2415
Practice Address - Country:US
Practice Address - Phone:915-533-7057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132103363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health