Healthcare Provider Details

I. General information

NPI: 1013871565
Provider Name (Legal Business Name): ADARA CARRILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11137 BREINER CT
RIVERSIDE CA
92505-2309
US

IV. Provider business mailing address

11137 BREINER CT
RIVERSIDE CA
92505-2309
US

V. Phone/Fax

Practice location:
  • Phone: 951-847-6218
  • Fax:
Mailing address:
  • Phone: 951-847-6218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: