Healthcare Provider Details

I. General information

NPI: 1336569276
Provider Name (Legal Business Name): GABRIEL P MURILLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2014
Last Update Date: 08/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 ZONAL AVE
LOS ANGELES CA
90033
US

IV. Provider business mailing address

1400 EAST PALOMAR ST
CHULA VISTA CA
91913
US

V. Phone/Fax

Practice location:
  • Phone: 323-226-5700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA126023
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: