Provider Demographics
NPI:1043714819
Name:DIAZ CARRILLO, YARICTZA
Entity type:Individual
Prefix:MS
First Name:YARICTZA
Middle Name:
Last Name:DIAZ CARRILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:YANCTZA
Other - Middle Name:
Other - Last Name:DIAZ CARRILLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1485 SARATOGA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-4965
Mailing Address - Country:US
Mailing Address - Phone:877-991-0009
Mailing Address - Fax:877-207-9553
Practice Address - Street 1:1485 SARATOGA AVE STE 200
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-4965
Practice Address - Country:US
Practice Address - Phone:877-991-0009
Practice Address - Fax:877-207-9553
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-19
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician