Provider Demographics
NPI:1073226049
Name:MURATALLA, BIANCA (NONE)
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:
Last Name:MURATALLA
Suffix:
Gender:F
Credentials:NONE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 W TOWN AND COUNTRY RD STE 1250
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4633
Mailing Address - Country:US
Mailing Address - Phone:949-357-2494
Mailing Address - Fax:855-568-2494
Practice Address - Street 1:1100 W TOWN AND COUNTRY RD STE 1250
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4633
Practice Address - Country:US
Practice Address - Phone:949-357-2494
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:No
Enumeration Date:2023-01-04
Last Update Date:2023-01-18
Deactivation Date:2023-01-04
Deactivation Code:
Reactivation Date:2023-01-12
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician