Provider Demographics
NPI:1326130832
Name:TRUJILLO, MORAIMA (MD)
Entity Type:Individual
Prefix:DR
First Name:MORAIMA
Middle Name:
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 N GREENWAY DR
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4759
Mailing Address - Country:US
Mailing Address - Phone:305-389-6822
Mailing Address - Fax:305-774-6030
Practice Address - Street 1:401 CORAL WAY
Practice Address - Street 2:SUITE 208-A
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4930
Practice Address - Country:US
Practice Address - Phone:305-446-4303
Practice Address - Fax:305-774-6030
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00417502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD27959Medicare UPIN
FL96191Medicare ID - Type Unspecified