Provider Demographics
NPI:1952581787
Name:MURILLO, MICHELLE E (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:E
Last Name:MURILLO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8020 YOLANDA AVE
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-1257
Mailing Address - Country:US
Mailing Address - Phone:760-567-1393
Mailing Address - Fax:
Practice Address - Street 1:8020 YOLANDA AVE
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-1257
Practice Address - Country:US
Practice Address - Phone:760-567-1393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9103956363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical