Provider Demographics
NPI:1568232650
Name:MURILLO, MICHELL A
Entity Type:Individual
Prefix:MISS
First Name:MICHELL
Middle Name:A
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 1:566 NAPLES ST APT 263
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-1855
Mailing Address - Country:US
Mailing Address - Phone:610-622-0975
Mailing Address - Fax:
Practice Address - Street 1:566 NAPLES ST APT 263
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-1855
Practice Address - Country:US
Practice Address - Phone:619-739-6734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA637165343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)