Provider Demographics
NPI:1043281744
Name:REZA-TRUJILLO, CESAR (MD)
Entity Type:Individual
Prefix:DR
First Name:CESAR
Middle Name:
Last Name:REZA-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 1:3822 COPPER BEND RD
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-8440
Mailing Address - Country:US
Mailing Address - Phone:956-740-7392
Mailing Address - Fax:
Practice Address - Street 1:619 W 54TH ST FL 8
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3545
Practice Address - Country:US
Practice Address - Phone:212-889-3142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2595207L00000X
NY315335207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K2463OtherBCBS
TX161511401Medicaid
TX161511403Medicaid
TXP00111215OtherMEDICARE RAILROAD
TX161511401Medicaid
TXTXB127829Medicare PIN
TXH52787Medicare UPIN