Provider Demographics
NPI:1932223914
Name:MURILLO, ADOLFO JR (OD)
Entity Type:Individual
Prefix:DR
First Name:ADOLFO
Middle Name:
Last Name:MURILLO
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:ADOLPH
Other - Middle Name:
Other - Last Name:MURILLO
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:961 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-6756
Mailing Address - Country:US
Mailing Address - Phone:805-240-1575
Mailing Address - Fax:805-240-1578
Practice Address - Street 1:961 W 7TH ST
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-6756
Practice Address - Country:US
Practice Address - Phone:805-240-1575
Practice Address - Fax:805-240-1578
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7726T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0077260Medicaid