Provider Demographics
NPI:1477937308
Name:TRUJILLO, FALLON PATRICIA II (MS)
Entity Type:Individual
Prefix:MRS
First Name:FALLON
Middle Name:PATRICIA
Last Name:TRUJILLO
Suffix:II
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13316 SW 128TH PSGE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5317
Mailing Address - Country:US
Mailing Address - Phone:561-285-7864
Mailing Address - Fax:
Practice Address - Street 1:13316 SW 128TH PSGE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5317
Practice Address - Country:US
Practice Address - Phone:561-285-7864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health