Provider Demographics
NPI:1093010340
Name:TRUJILLO, KATHY
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 OLD HOT SPRINGS RD
Mailing Address - Street 2:SUITE 157
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-0782
Mailing Address - Country:US
Mailing Address - Phone:775-687-5162
Mailing Address - Fax:775-687-1214
Practice Address - Street 1:1000 C ST
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:NV
Practice Address - Zip Code:89415-0000
Practice Address - Country:US
Practice Address - Phone:775-975-3387
Practice Address - Fax:775-975-2307
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator