Provider Demographics
NPI:1104355320
Name:CARRILLO, JAZMIN
Entity type:Individual
Prefix:MS
First Name:JAZMIN
Middle Name:
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2329 N KIMBERLY DR
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-7168
Mailing Address - Country:US
Mailing Address - Phone:575-519-0089
Mailing Address - Fax:
Practice Address - Street 1:2329 N KIMBERLY DR
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-7168
Practice Address - Country:US
Practice Address - Phone:575-519-0089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-10
Last Update Date:2017-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician