Individual
GIOVANNE MURILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1940 BASELINE RD, LA VERNE, CA 91750-2148
(626) 940-8859
Mailing address
158 GENTRY ST, POMONA, CA 91767-2100
(909) 599-8222
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19BZ
MEDI-CAL
CA
01
—
19C1
MEDI-CAL
CA
01
—
19C2
MEDI-CAL
CA
01
—
19C3
MEDI-CAL
CA
Enumeration date
02/26/2021
Last updated
02/26/2021
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