Provider Demographics
NPI:1427893155
Name:MURILLO, JANITZY DAFNE
Entity type:Individual
Prefix:
First Name:JANITZY
Middle Name:DAFNE
Last Name:MURILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6736 LAUREL CANYON BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-1576
Mailing Address - Country:US
Mailing Address - Phone:818-755-8786
Mailing Address - Fax:818-755-8789
Practice Address - Street 1:6736 LAUREL CANYON BLVD STE 200
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-1576
Practice Address - Country:US
Practice Address - Phone:818-755-8786
Practice Address - Fax:818-755-8789
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-4625826Medicaid