Healthcare Provider Details

I. General information

NPI: 1760536205
Provider Name (Legal Business Name): PSYCHE MURILLO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 WILLOW PASS RD
CONCORD CA
94520-5223
US

IV. Provider business mailing address

836 DANROSE DR
AMERICAN CANYON CA
94503-4131
US

V. Phone/Fax

Practice location:
  • Phone: 707-646-5480
  • Fax:
Mailing address:
  • Phone: 707-645-0208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number391075
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: