Provider Demographics
NPI:1225724222
Name:CARRILLO, ALEJANDRO ELIAS
Entity type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:ELIAS
Last Name:CARRILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2455 FLORES ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-6702
Mailing Address - Country:US
Mailing Address - Phone:909-301-1939
Mailing Address - Fax:
Practice Address - Street 1:2455 FLORES ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407-6702
Practice Address - Country:US
Practice Address - Phone:909-775-8391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician