Individual
TANYA CARRILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
5198 IROQUOIS AVE, EWA BEACH, HI 96706-3252
(619) 947-9881
Mailing address
5198 IROQUOIS AVE, EWA BEACH, HI 96706-3252
(619) 947-9881
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
HI
Other
Enumeration date
03/13/2018
Last updated
03/13/2018
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