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General NPI Number Information
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NPI Number | 1992752406
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Entity Type | Individual
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Provider Name | CARMEN DE LLANO PH.D.
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Gender | Female
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Dates
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Enumeration Date | 05/28/2006
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 815 3RD AVE STE 107
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City | CHULA VISTA
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State | CA
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Zip | 91911-1308
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Country | US
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Telephone | 619-584-6299
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Fax | 833-262-7523
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Provider Business Mailing Address
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Address Line | 14226 OAK SHADOWS
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City | SAN ANTONIO
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State | TX
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Zip | 78232-4419
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Country | US
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Telephone | 619-847-5100
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Fax | 833-262-7523
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 11154
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License Number State | CA
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