MEDICARE: CLAUDIA MURILLO CADC II, SAP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	A011540315	CA

General Provider Information

NPI Number	:	1457899262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLAUDIA MURILLO CADC II, SAP

Provider Business Mailing Address
First Line	:	235 W 9TH ST
Second Line	:
City	:	SAN PEDRO
State	:	CA
Zip	:	90731-3711
Country	:	US
Telephone Number	:	310-521-9209
Fax Number	:	310-521-9241

Provider Business Practice Location Address
First Line	:	235 W 9TH ST
Second Line	:
City	:	SAN PEDRO
State	:	CA
Zip	:	90731-3711
Country	:	US
Telephone Number	:	310-521-9209
Fax Number	:	310-521-9241

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2017
Last Update Date	:	02/01/2017

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