Individual
LISA MARIE CARRILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CERTIFIED PFA
Contact information
Practice address
18818 US HIGHWAY 18, APPLE VALLEY, CA 92307-2323
(760) 995-8891
Mailing address
18818 US HIGHWAY 18, APPLE VALLEY, CA 92307-2323
(760) 995-8891
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
—
—
372600000X
Adult Companion
Primary
MPSSVGHYZX
CA
Other
Enumeration date
08/07/2024
Last updated
05/02/2025
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