Provider Demographics
NPI:1043923519
Name:PEREZ-CARRILLO, RYAN STEVEN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:STEVEN
Last Name:PEREZ-CARRILLO
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7450 W CHEYENNE AVE
Mailing Address - Street 2:SUITE 103 PMB 1261
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-1592
Mailing Address - Country:US
Mailing Address - Phone:702-527-3142
Mailing Address - Fax:
Practice Address - Street 1:7121 W CRAIG RD STE 113-1207
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-6001
Practice Address - Country:US
Practice Address - Phone:702-527-3142
Practice Address - Fax:702-549-7717
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-29
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36625235Z00000X
NVSP-3551235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV250024774Medicaid