Provider Demographics
NPI:1033115647
Name:TRUJILLO, FERNANDO (MD)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:
Last Name:TRUJILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 E BASSE RD
Mailing Address - Street 2:STE 103
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1802
Mailing Address - Country:US
Mailing Address - Phone:210-538-2020
Mailing Address - Fax:210-599-6622
Practice Address - Street 1:999 E BASSE RD
Practice Address - Street 2:STE 103
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1802
Practice Address - Country:US
Practice Address - Phone:210-538-2020
Practice Address - Fax:210-599-6622
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7233207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX522957ZV6YOtherMEDICARE PTAN
TX165798303Medicaid
TX00K63QMedicare ID - Type Unspecified
TXI04982Medicare UPIN