Provider Demographics
NPI:1336961754
Name:CARRILLO, ERIKA (CHWI)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:CHWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 362
Mailing Address - Street 2:
Mailing Address - City:BOVINA
Mailing Address - State:TX
Mailing Address - Zip Code:79009-0362
Mailing Address - Country:US
Mailing Address - Phone:806-400-6113
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 362
Practice Address - Street 2:
Practice Address - City:BOVINA
Practice Address - State:TX
Practice Address - Zip Code:79009-0362
Practice Address - Country:US
Practice Address - Phone:806-400-6113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13493172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker