Provider Demographics
NPI:1255107132
Name:NIETO MURILLO, LOURDES
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:
Last Name:NIETO 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 1:1011 E DEVONSHIRE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-3033
Mailing Address - Country:US
Mailing Address - Phone:714-353-0734
Mailing Address - Fax:
Practice Address - Street 1:1011 E DEVONSHIRE AVE STE 101
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-3033
Practice Address - Country:US
Practice Address - Phone:714-353-0734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker