Provider Demographics
NPI:1174924724
Name:CARRILLO, DARYN R (BC-HIS, ACA)
Entity type:Individual
Prefix:MS
First Name:DARYN
Middle Name:R
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:BC-HIS, ACA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14201 KENTWOOD BLVD
Mailing Address - Street 2:STE 2
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-2472
Mailing Address - Country:US
Mailing Address - Phone:760-952-2727
Mailing Address - Fax:760-952-2247
Practice Address - Street 1:14201 KENTWOOD BLVD
Practice Address - Street 2:STE 2
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-2472
Practice Address - Country:US
Practice Address - Phone:760-952-2727
Practice Address - Fax:760-952-2247
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA3245237700000X
NV184237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist