Healthcare Provider Details

I. General information

NPI: 1841117058
Provider Name (Legal Business Name): YESENIA CARRILLO LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 N CAMINO MERCADO STE 2
CASA GRANDE AZ
85122-5750
US

IV. Provider business mailing address

8444 N 90TH ST STE 100
SCOTTSDALE AZ
85258-4437
US

V. Phone/Fax

Practice location:
  • Phone: 520-424-7390
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number292352
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: