Basic Information
| Provider Information | |||||||||
| NPI: | 1144296641 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MURILLO | ||||||||
| FirstName: | JAIME | ||||||||
| MiddleName: | EDWARDO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 BUSINESS PARK DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234626535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7579621083 | ||||||||
| FaxNumber: | 7579621254 | ||||||||
| Practice Location | |||||||||
| Address1: | 844 KEMPSVILLE RD | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235023927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572610700 | ||||||||
| FaxNumber: | 7579621254 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2006 | ||||||||
| LastUpdateDate: | 03/20/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 0101230983 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 389716 | 01 | VA | MAMSI | OTHER | 440509 | 01 | VA | ATHEM BC/BS VA/HK | OTHER | -001 | 01 | VA | CHAMPUS/TRICARE | OTHER | PAR | 01 | VIRGINIA HEALTH NETWORK | OTHER | PAR | 01 | USA MANAGED CARE | OTHER | PAR | 01 | FIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY | OTHER | 005856124 | 05 | VA | MEDICAID | 89064EY | 05 | NC | MEDICAID | PAR | 01 | MULTIPLAN | OTHER | 15792 | 01 | VA | SENTARA OHP/SHP | OTHER | 689716 | 01 | VA | UHC/MAMSI/MDIPA | OTHER | PAR | 01 | CIGNA | OTHER | PAR | 01 | AETNA | OTHER | 005801559 | 05 | VA | MEDICAID | 064MJ | 01 | NC | BC/BS NC | OTHER | 218181 | 01 | VA | ANTHEM BC/BS AND HKP | OTHER | 38293 | 01 | VA | OPTIMA HEALTH PLAN | OTHER | 89064MJ | 05 | NC | MEDICAID | PAR | 01 | VIRGINIA PREMIER HEALTH | OTHER | PAR | 01 | CORVEL/CORCARE | OTHER |