Provider Demographics
NPI:1396351326
Name:MURILLO, VANESSA KATRINA (FNP-C)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:KATRINA
Last Name:MURILLO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13406 N MANZANILLO LN
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-3175
Mailing Address - Country:US
Mailing Address - Phone:818-282-8262
Mailing Address - Fax:
Practice Address - Street 1:17075 DEVONSHIRE ST STE 303
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-5412
Practice Address - Country:US
Practice Address - Phone:818-488-1840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013349363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95013349Medicaid