Provider Demographics
NPI:1427369305
Name:MURILLO, RUDY (MD)
Entity Type:Individual
Prefix:
First Name:RUDY
Middle Name:
Last Name:MURILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 DUNSTER RD # 1
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2703
Mailing Address - Country:US
Mailing Address - Phone:858-869-3377
Mailing Address - Fax:
Practice Address - Street 1:25 DUNSTER RD # 1
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2703
Practice Address - Country:US
Practice Address - Phone:858-869-3377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA244320208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery