Provider Demographics
NPI:1619857026
Name:CARRILLO, YAHAIRA GUADALUPE (PPS)
Entity type:Individual
Prefix:
First Name:YAHAIRA
Middle Name:GUADALUPE
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 HIDALGO ST
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:CA
Mailing Address - Zip Code:95329-8619
Mailing Address - Country:US
Mailing Address - Phone:209-852-2144
Mailing Address - Fax:209-852-2184
Practice Address - Street 1:2411 HIDALGO ST
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:CA
Practice Address - Zip Code:95329-8619
Practice Address - Country:US
Practice Address - Phone:209-852-2144
Practice Address - Fax:209-852-2184
Is Sole Proprietor?:No
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool