Healthcare Provider Details

I. General information

NPI: 1770813982
Provider Name (Legal Business Name): MARCO ANTONIO MURILLO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2010
Last Update Date: 01/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3D MED BN, 3D MLG H&S CO. UNIT # 38446
FPO AP
96604-8446
US

IV. Provider business mailing address

3D MED BN, 3D MLG H&S CO. UNIT # 38446
FPO AP
96604-8446
US

V. Phone/Fax

Practice location:
  • Phone: 315-623-4960
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: