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General NPI Number Information
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NPI Number | 1891923231
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Entity Type | Individual
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Provider Name | AJA CARRILLO SLP
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Gender | Female
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Dates
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Enumeration Date | 06/24/2009
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Last Update Date | 07/19/2022
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Provider Practice Location Address
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Address Line | 420 JAMES RIVER RD
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City | GULF BREEZE
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State | FL
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Zip | 32561-4867
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Country | US
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Telephone | 831-309-2101
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Fax | 877-215-7951
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Provider Business Mailing Address
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Address Line | 310 A ST APT 1807
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City | SAN DIEGO
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State | CA
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Zip | 92101-4314
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Country | US
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Telephone | 850-481-3114
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Fax | 877-215-7951
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 32410
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA10343
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License Number State | FL
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