Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 32769 | CA |
NPI | 1407202013 |
---|---|
Provider Name | Dr. Carlos Murillo Moreno |
First Address | Long Beach, CA 90806 |
Second Address | Long Beach, CA 90806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2016 |
Last Update Date | 12/05/2016 |