Provider Demographics
NPI:1467960872
Name:MURILLO, RUTH ELIZABETH
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:ELIZABETH
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 1:12401 W OKEECHOBEE RD LOT 234
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-2931
Mailing Address - Country:US
Mailing Address - Phone:786-461-2364
Mailing Address - Fax:
Practice Address - Street 1:11602 NW 4TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-4940
Practice Address - Country:US
Practice Address - Phone:786-763-5406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-19
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician