Individual
MIA CARRILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4444 CORONA DR STE 144, CORPUS CHRISTI, TX 78411-4322
(361) 854-1110
Mailing address
4444 CORONA DR STE 144, CORPUS CHRISTI, TX 78411-4322
(361) 854-1110
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
210300
TX
Other
Enumeration date
12/13/2017
Last updated
12/13/2017
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