Healthcare Provider Details

I. General information

NPI: 1477147718
Provider Name (Legal Business Name): GIOVANNE MURILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 BASELINE RD
LA VERNE CA
91750-2148
US

IV. Provider business mailing address

158 GENTRY ST
POMONA CA
91767-2100
US

V. Phone/Fax

Practice location:
  • Phone: 626-940-8859
  • Fax:
Mailing address:
  • Phone: 909-599-8222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: