Healthcare Provider Details

I. General information

NPI: 1942506001
Provider Name (Legal Business Name): IMELDA MURILLO MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2011
Last Update Date: 02/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21530 PIONEER BLVD
HAWAIIAN GARDENS CA
90716-2608
US

IV. Provider business mailing address

PO BOX 788
HEMET CA
92546-0788
US

V. Phone/Fax

Practice location:
  • Phone: 562-860-0401
  • Fax: 562-924-5871
Mailing address:
  • Phone: 951-929-6260
  • Fax: 951-765-2855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA55681
License Number StateCA

VIII. Authorized Official

Name: IMELDA MURILLO
Title or Position: PRESIDENT
Credential: MD
Phone: 951-929-6260