Provider Demographics
NPI:1578630992
Name:DAVIS-TRUJILLO, REBECCA S (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:S
Last Name:DAVIS-TRUJILLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:SUE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 425
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80901-0425
Mailing Address - Country:US
Mailing Address - Phone:719-641-2376
Mailing Address - Fax:719-632-7160
Practice Address - Street 1:1715 N WEBER ST
Practice Address - Street 2:SUITE 270
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-7532
Practice Address - Country:US
Practice Address - Phone:719-473-8595
Practice Address - Fax:719-473-8593
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31545207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COF44424Medicare UPIN