Provider Demographics
NPI:1073511887
Name:TRUJILLO, NICOLAS E (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:E
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 1:5269 N 23RD ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-4010
Mailing Address - Country:US
Mailing Address - Phone:956-278-3777
Mailing Address - Fax:800-396-9360
Practice Address - Street 1:5000 N 23RD ST
Practice Address - Street 2:SUITE K
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-4013
Practice Address - Country:US
Practice Address - Phone:956-278-3777
Practice Address - Fax:800-396-9360
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3165208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145491009Medicaid
TX8B6212Medicare ID - Type UnspecifiedMEDICARE NUMBER
TXH50576Medicare UPIN