Provider Demographics
NPI:1558146258
Name:TRUJILLO, YESSICA (RADT)
Entity Type:Individual
Prefix:
First Name:YESSICA
Middle Name:
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5870 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-2037
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19531 MCLANE ST
Practice Address - Street 2:
Practice Address - City:NORTH PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92258
Practice Address - Country:US
Practice Address - Phone:760-778-2083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)