Provider Demographics
NPI:1568929271
Name:TRUJILLO, DIANA YVETTE
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:YVETTE
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:DIANA
Other - Middle Name:YVETTE
Other - Last Name:ROLDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:572 N ARROWHEAD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92401-1217
Mailing Address - Country:US
Mailing Address - Phone:626-684-2319
Mailing Address - Fax:
Practice Address - Street 1:572 N ARROWHEAD AVE STE 100
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401-1217
Practice Address - Country:US
Practice Address - Phone:626-684-2319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT109772101YM0800X
CA109772106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health