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General NPI Number Information
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NPI Number | 1174487482
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Entity Type | Individual
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Provider Name | DOMINIQUE CARRILLO
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Gender | Female
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Dates
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Enumeration Date | 12/11/2025
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 2224 N CRAYCROFT RD STE 100
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City | TUCSON
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State | AZ
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Zip | 85712-2811
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Country | US
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Telephone | 520-201-0730
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Fax | 520-614-6050
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Provider Business Mailing Address
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Address Line | 2850 N COUNTRY CLUB RD
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City | TUCSON
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State | AZ
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Zip | 85716-1910
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Country | US
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Telephone | 520-322-6274
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Fax | 520-509-4496
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 23475
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License Number State | AZ
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