Provider Demographics
NPI:1326426040
Name:MURILLO, ESTELA
Entity Type:Individual
Prefix:
First Name:ESTELA
Middle Name:
Last Name:MURILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16229 S WESTERN AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4660
Mailing Address - Country:US
Mailing Address - Phone:310-756-6606
Mailing Address - Fax:323-480-4551
Practice Address - Street 1:16229 S WESTERN AVE STE 2
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4660
Practice Address - Country:US
Practice Address - Phone:310-756-6606
Practice Address - Fax:323-480-4551
Is Sole Proprietor?:No
Enumeration Date:2015-05-14
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64476122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA64476OtherDENTAL LICENSE