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General NPI Number Information
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NPI Number | 1801319702
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Entity Type | Individual
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Provider Name | FABIO MURILLO LAC
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Gender | Male
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Dates
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Enumeration Date | 07/23/2017
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Last Update Date | 07/23/2017
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Provider Practice Location Address
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Address Line | 70 GLEN ST STE 380
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City | GLEN COVE
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State | NY
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Zip | 11542-2858
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Country | US
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Telephone | 516-852-1821
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Fax |
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Provider Business Mailing Address
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Address Line | 15 CANDY LN
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City | SYOSSET
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State | NY
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Zip | 11791-4909
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Country | US
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Telephone | 516-852-1821
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 005474
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License Number State | NY
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