Individual
KAYLA CARRILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
HIGHWAY 264 MILEPOST 388, POLACCA, AZ 86042
(928) 737-6001
Mailing address
PO BOX 4000, POLACCA, AZ 86042-4000
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
1668957
CO
Other
Enumeration date
12/10/2021
Last updated
12/10/2021
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