Provider Demographics
NPI:1548371321
Name:MURILLO, IMELDA F (MD)
Entity type:Individual
Prefix:DR
First Name:IMELDA
Middle Name:F
Last Name:MURILLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2735
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91708-2735
Mailing Address - Country:US
Mailing Address - Phone:909-465-6464
Mailing Address - Fax:909-465-9544
Practice Address - Street 1:5385 WALNUT AVE
Practice Address - Street 2:SUITE NO. 5
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2605
Practice Address - Country:US
Practice Address - Phone:909-465-6464
Practice Address - Fax:909-465-9544
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA055681207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A556811Medicaid
CA00A556812Medicaid
CA00A556810Medicaid
CAA055681Medicare UPIN
CA00A556812Medicaid
CA00A556810Medicaid