Provider Demographics
NPI:1497833891
Name:TRUJILLO, ROBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
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 1:2400 MISSION ST
Mailing Address - Street 2:209
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-1632
Mailing Address - Country:US
Mailing Address - Phone:626-403-7400
Mailing Address - Fax:626-585-8892
Practice Address - Street 1:2400 MISSION ST
Practice Address - Street 2:209
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-1632
Practice Address - Country:US
Practice Address - Phone:626-403-7400
Practice Address - Fax:626-585-8892
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10273103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical