Provider Demographics
NPI:1083355531
Name:HENDERSON TRUJILLO, COREY (DO)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:HENDERSON TRUJILLO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:COREY
Other - Middle Name:
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16620 E ATLANTIC PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-1209
Mailing Address - Country:US
Mailing Address - Phone:530-519-8894
Mailing Address - Fax:
Practice Address - Street 1:2211 NE 139TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-2742
Practice Address - Country:US
Practice Address - Phone:360-487-1168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program