Provider Demographics
NPI:1114694676
Name:TRUJILLO, BRAYDEN REY
Entity Type:Individual
Prefix:
First Name:BRAYDEN
Middle Name:REY
Last Name:TRUJILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 TRANSPORT ST SE UNIT 5
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4307
Mailing Address - Country:US
Mailing Address - Phone:505-728-5155
Mailing Address - Fax:
Practice Address - Street 1:3003 TRANSPORT ST SE UNIT 5
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4307
Practice Address - Country:US
Practice Address - Phone:505-728-5155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer