Healthcare Provider Details

I. General information

NPI: 1558226225
Provider Name (Legal Business Name): JOANNA MURILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GLADYS ISABEL REYES CPT

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8440 SCENIC DR UNIT 38
RANCHO CUCAMONGA CA
91730-3588
US

IV. Provider business mailing address

8440 SCENIC DR UNIT 38
RANCHO CUCAMONGA CA
91730-3588
US

V. Phone/Fax

Practice location:
  • Phone: 909-938-2123
  • Fax:
Mailing address:
  • Phone: 909-938-2123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberCPT-00029739
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: