Individual
MIKAELA CARRILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, CD
Contact information
Practice address
2020 E 29TH AVE STE 210, SPOKANE, WA 99203-3950
(949) 697-1175
Mailing address
2020 E 29TH AVE STE 210, SPOKANE, WA 99203-3950
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
6
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86070124
COMMISSION ON DIETETIC REGISTRATION
—
Enumeration date
04/27/2018
Last updated
04/27/2018
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