Provider Demographics
NPI:1215325691
Name:CARRILLO, YOLANDA M (AP, DOM)
Entity type:Individual
Prefix:MRS
First Name:YOLANDA
Middle Name:M
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:AP, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 HOWLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-9700
Mailing Address - Country:US
Mailing Address - Phone:407-476-1818
Mailing Address - Fax:321-476-4842
Practice Address - Street 1:1329 HOWLAND BLVD
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738-9700
Practice Address - Country:US
Practice Address - Phone:407-476-1818
Practice Address - Fax:321-476-4842
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-07
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL64-44-22919702255A2300X
FLAP 3175171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer