Provider Demographics
NPI:1669086195
Name:MURILLO, AMELIA NICOLE (BSW)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:NICOLE
Last Name:MURILLO
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25800 DATE ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-3447
Mailing Address - Country:US
Mailing Address - Phone:909-725-0043
Mailing Address - Fax:
Practice Address - Street 1:790 VIA LATA STE 300
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3978
Practice Address - Country:US
Practice Address - Phone:909-433-0445
Practice Address - Fax:909-494-7635
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator