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General NPI Number Information
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NPI Number | 1992213953
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Entity Type | Individual
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Provider Name | ARIANA ALICIA DEAN CARRILLO
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Gender | Female
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Dates
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Enumeration Date | 01/11/2018
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Last Update Date | 01/11/2018
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Provider Practice Location Address
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Address Line | 601 MAIN ST SE
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City | LOS LUNAS
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State | NM
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Zip | 87031-4308
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Country | US
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Telephone | 505-508-3503
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Fax |
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Provider Business Mailing Address
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Address Line | 1816 REGENCY PARK RD SE
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City | RIO RANCHO
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State | NM
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Zip | 87124-7114
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Country | US
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Telephone | 505-414-5484
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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 | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State | NM
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