Provider Demographics
NPI:1073755567
Name:TRUJILLO, LOUIS ALEXANDER (CSA)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:ALEXANDER
Last Name:TRUJILLO
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 NW 186TH ST APT 4-114
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3121
Mailing Address - Country:US
Mailing Address - Phone:305-721-0082
Mailing Address - Fax:
Practice Address - Street 1:1211 W 61ST PL
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-6314
Practice Address - Country:US
Practice Address - Phone:305-725-7202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL#CSA3797246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant