Healthcare Provider Details

I. General information

NPI: 1770855264
Provider Name (Legal Business Name): CRISTINA MURILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2012
Last Update Date: 01/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 EDMONDS RD
REDWOOD CITY CA
94062-3813
US

IV. Provider business mailing address

200 EDMONDS RD
REDWOOD CITY CA
94062-3813
US

V. Phone/Fax

Practice location:
  • Phone: 650-367-1890
  • Fax: 650-369-6465
Mailing address:
  • Phone: 650-367-1890
  • Fax: 650-369-6465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number21397
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: