Provider Demographics
NPI:1003677196
Name:TRUJILLO, TAMARA (CPSW)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:CPSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 PASEO DEL PUEBLO SUR
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-5972
Mailing Address - Country:US
Mailing Address - Phone:575-779-9889
Mailing Address - Fax:
Practice Address - Street 1:1333 PASEO DEL PUEBLO SUR
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-5972
Practice Address - Country:US
Practice Address - Phone:575-779-9889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM913175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist