Provider Demographics
NPI:1902786270
Name:CARRILLO, MAYA GISEL (MA, CF-SLP)
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:GISEL
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 N QUINCY CT
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-9159
Mailing Address - Country:US
Mailing Address - Phone:559-750-1604
Mailing Address - Fax:
Practice Address - Street 1:1426 N KAWEAH AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-8067
Practice Address - Country:US
Practice Address - Phone:559-961-3535
Practice Address - Fax:
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
CA20148235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist