Healthcare Provider Details

I. General information

NPI: 1255205795
Provider Name (Legal Business Name): EDWARD MURILLO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 CAMINO DEL SOL STE 1
OXNARD CA
93030-3725
US

IV. Provider business mailing address

368 SPRING OAK RD UNIT 1837
CAMARILLO CA
93010-7536
US

V. Phone/Fax

Practice location:
  • Phone: 805-604-5437
  • Fax:
Mailing address:
  • Phone: 805-512-5611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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: