Healthcare Provider Details

I. General information

NPI: 1427748326
Provider Name (Legal Business Name): CECILIA CUSIMANO MURILLO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2023
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 FOOTHILL BLVD STE B
LA VERNE CA
91750-3027
US

IV. Provider business mailing address

1601 MONTE VISTA AVE STE 260
CLAREMONT CA
91711-6604
US

V. Phone/Fax

Practice location:
  • Phone: 909-392-6501
  • Fax: 909-469-2136
Mailing address:
  • Phone: 909-865-9501
  • Fax: 909-469-2146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA205043
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: