Healthcare Provider Details

I. General information

NPI: 1053465138
Provider Name (Legal Business Name): SONIA L MURILLO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N MAIN AVE
LOVINGTON NM
88260-2830
US

IV. Provider business mailing address

1600 NORTH MAIN
LOVINGTON NM
88260-2813
US

V. Phone/Fax

Practice location:
  • Phone: 575-396-6611
  • Fax: 575-396-1454
Mailing address:
  • Phone: 575-396-6611
  • Fax: 575-396-1454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD2004-0226
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: