Provider Demographics
NPI:1780218198
Name:MURILLO, SARAH ROSE (MA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ROSE
Last Name:MURILLO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ROSE
Other - Last Name:HARTUNIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:1005 CARSON ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-5611
Mailing Address - Country:US
Mailing Address - Phone:831-869-1179
Mailing Address - Fax:
Practice Address - Street 1:1001 SNEATH LN STE 200
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-2349
Practice Address - Country:US
Practice Address - Phone:916-005-4438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA99147779D5OtherMEDICAL