Provider Demographics
NPI:1336501444
Name:TRUJILLO, MICHAEL (NBCHIS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:TRUJILLO
Suffix:
Gender:M
Credentials:NBCHIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2032 PEPPER LN
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-3278
Mailing Address - Country:US
Mailing Address - Phone:719-564-2966
Mailing Address - Fax:719-564-7718
Practice Address - Street 1:2032 PEPPER LN
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-3278
Practice Address - Country:US
Practice Address - Phone:719-564-2966
Practice Address - Fax:719-564-7718
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COHAD.0000107237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist