Provider Demographics
NPI:1609093269
Name:MURCH, JILL (COTA)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:MURCH
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S KRAEMER BLVD
Mailing Address - Street 2:STE. 206
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-6105
Mailing Address - Country:US
Mailing Address - Phone:714-961-8288
Mailing Address - Fax:714-524-3753
Practice Address - Street 1:802 MAGNOLIA AVE
Practice Address - Street 2:STE106
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3104
Practice Address - Country:US
Practice Address - Phone:951-734-0134
Practice Address - Fax:951-734-0724
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA536174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
W15353Medicare UPIN