Provider Demographics
NPI:1306865886
Name:TRUJILLO, CANDIDO (PHD)
Entity Type:Individual
Prefix:DR
First Name:CANDIDO
Middle Name:
Last Name:TRUJILLO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13375 RIDGELANE DR NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-9519
Mailing Address - Country:US
Mailing Address - Phone:360-271-6966
Mailing Address - Fax:
Practice Address - Street 1:1007 SCOTT AVE
Practice Address - Street 2:SUITE D
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-4874
Practice Address - Country:US
Practice Address - Phone:360-377-9032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00007716101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health