Provider Demographics
NPI:1114255395
Name:TRUJILLO, MARIZA (OT)
Entity Type:Individual
Prefix:
First Name:MARIZA
Middle Name:
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:MARIZA
Other - Middle Name:
Other - Last Name:TRUJILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:12537 STILLMAN ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90715-1817
Mailing Address - Country:US
Mailing Address - Phone:213-798-1384
Mailing Address - Fax:
Practice Address - Street 1:12537 STILLMAN ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90715-1817
Practice Address - Country:US
Practice Address - Phone:213-798-1384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-25
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9133225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9133OtherOT