Healthcare Provider Details

I. General information

NPI: 1467316562
Provider Name (Legal Business Name): MARIANA MENESES MURILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12970 SR-9
ALPHARETTA GA
30004
US

IV. Provider business mailing address

4835 MARJORIE DR
CUMMING GA
30041-1352
US

V. Phone/Fax

Practice location:
  • Phone: 678-370-9990
  • Fax:
Mailing address:
  • Phone: 470-422-2832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-86177
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: