Provider Demographics
NPI:1770091316
Name:MURILLO-DELUQUEZ, MARCELINO ENRIQUE (MD)
Entity type:Individual
Prefix:
First Name:MARCELINO
Middle Name:ENRIQUE
Last Name:MURILLO-DELUQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4949 W PINE BLVD APT 8E
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-1474
Mailing Address - Country:US
Mailing Address - Phone:754-551-9412
Mailing Address - Fax:314-747-2179
Practice Address - Street 1:660 S EUCLID AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1010
Practice Address - Country:US
Practice Address - Phone:314-747-2178
Practice Address - Fax:314-747-2179
Is Sole Proprietor?:No
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017041420390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program