Provider Demographics
NPI:1932901121
Name:MURILLO, PRISCILA
Entity type:Individual
Prefix:
First Name:PRISCILA
Middle Name:
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 1:160 S EUCALYPTUS AVE SPC 29
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-6658
Mailing Address - Country:US
Mailing Address - Phone:909-265-6321
Mailing Address - Fax:
Practice Address - Street 1:245 E REDLANDS BLVD STE A
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3760
Practice Address - Country:US
Practice Address - Phone:909-301-8904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-26
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty