Provider Demographics
NPI:1992752406
Name:DE LLANO, CARMEN (PHD)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:
Last Name:DE LLANO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14226 OAK SHADOWS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-4419
Mailing Address - Country:US
Mailing Address - Phone:619-847-5100
Mailing Address - Fax:833-262-7523
Practice Address - Street 1:815 3RD AVE STE 107
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-1308
Practice Address - Country:US
Practice Address - Phone:619-584-6299
Practice Address - Fax:833-262-7523
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11154103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY 11154/1Medicaid
CA11154OtherCLINICAL PHYCHOLOGY