Provider Demographics
NPI:1720835184
Name:REA-MURILLO, SAMANTHA JUDITH
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JUDITH
Last Name:REA-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 1:7809 SINBAD CT
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95828-5350
Mailing Address - Country:US
Mailing Address - Phone:916-796-2743
Mailing Address - Fax:
Practice Address - Street 1:9355 E STOCKTON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-9476
Practice Address - Country:US
Practice Address - Phone:916-683-1109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician