Provider Demographics
NPI:1346339900
Name:TRUJILLO, JORGE MARIO (MD,PHD,MPH)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:MARIO
Last Name:TRUJILLO
Suffix:
Gender:M
Credentials:MD,PHD,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6914 AQUEDUCT TER
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-1867
Mailing Address - Country:US
Mailing Address - Phone:813-792-1273
Mailing Address - Fax:
Practice Address - Street 1:900 CARILLON PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-1115
Practice Address - Country:US
Practice Address - Phone:727-556-2662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 806212083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine