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General NPI Number Information
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NPI Number | 1215580030
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Entity Type | Individual
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Provider Name | MRS. MAEGAN B CARRILLO
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Gender | Female
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Dates
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Enumeration Date | 07/21/2019
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Last Update Date | 07/21/2019
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Provider Practice Location Address
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Address Line | 22211 IH 10 W STE 1206
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City | SAN ANTONIO
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State | TX
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Zip | 78257-1742
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Country | US
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Telephone | 210-742-5995
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Fax |
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Provider Business Mailing Address
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Address Line | 218 EMPRESARIO DR
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City | SAN ANTONIO
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State | TX
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Zip | 78253-9217
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Country | US
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Telephone | 210-995-5302
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Fax |
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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 | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | 39179
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License Number State | TX
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