Healthcare Provider Details

I. General information

NPI: 1942125901
Provider Name (Legal Business Name): MRS. TAYLIR LEE CARRILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2970 N LITCHFIELD RD STE 110
GOODYEAR AZ
85395-7831
US

IV. Provider business mailing address

6814 W ST ANNE AVE
LAVEEN AZ
85339-5056
US

V. Phone/Fax

Practice location:
  • Phone: 480-569-1547
  • Fax:
Mailing address:
  • Phone: 602-810-4695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: