Provider Demographics
NPI:1205377058
Name:TRUJILLO, DONNA (MA, MFT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35751 GATEWAY DR UNIT H813
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-6041
Mailing Address - Country:US
Mailing Address - Phone:310-739-4561
Mailing Address - Fax:
Practice Address - Street 1:6815 WILLOUGHBY AVE STE 201
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90038-2424
Practice Address - Country:US
Practice Address - Phone:310-289-4448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-13
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA98702106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist