Provider Demographics
NPI:1093196545
Name:TRUJILLO, PATRICIA
Entity Type:Individual
Prefix:
First Name:PATRICIA
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 1:282 S CAMINO DEL PUEBLO
Mailing Address - Street 2:STE 2-C
Mailing Address - City:BERNALILLO
Mailing Address - State:NM
Mailing Address - Zip Code:87004-5909
Mailing Address - Country:US
Mailing Address - Phone:505-288-3893
Mailing Address - Fax:
Practice Address - Street 1:904 E FAIRVIEW LN
Practice Address - Street 2:B
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2822
Practice Address - Country:US
Practice Address - Phone:505-747-1991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator