Provider Demographics
NPI:1528565769
Name:TRUJILLO ROMAN, LUIS ADRIAN
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ADRIAN
Last Name:TRUJILLO ROMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:LUIS
Other - Middle Name:ADRIAN
Other - Last Name:TRUJILLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5550 W FLAMINGO RD STE C5
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-0137
Mailing Address - Country:US
Mailing Address - Phone:702-877-2520
Mailing Address - Fax:
Practice Address - Street 1:5550 W FLAMINGO RD STE C5
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-0137
Practice Address - Country:US
Practice Address - Phone:702-877-2520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-15-04244106S00000X
NV1-21-56907103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician