Basic Information
Provider Information | |||||||||
NPI: | 1548535958 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MURILLO | ||||||||
FirstName: | ELIAS | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.C | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1040 FLYNN RD | ||||||||
Address2: |   | ||||||||
City: | CAMARILLO | ||||||||
State: | CA | ||||||||
PostalCode: | 930125092 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8056733930 | ||||||||
FaxNumber: | 8056593217 | ||||||||
Practice Location | |||||||||
Address1: | 1200 N VENTURA RD STE E | ||||||||
Address2: |   | ||||||||
City: | OXNARD | ||||||||
State: | CA | ||||||||
PostalCode: | 93030 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8059880053 | ||||||||
FaxNumber: | 8059880554 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/19/2012 | ||||||||
LastUpdateDate: | 08/13/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111NX0800X | DC31388 | CA | Y |   | Chiropractic Providers | Chiropractor | Orthopedic |
ID Information
ID | Type | State | Issuer | Description | DC31388 | 01 | CA | CALIFORNIA STATE LICENCE | OTHER |