Provider Demographics
NPI:1598140824
Name:TRUJILLO, IRMA (BILLER)
Entity Type:Individual
Prefix:MRS
First Name:IRMA
Middle Name:
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:BILLER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1597
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NM
Mailing Address - Zip Code:88029-1597
Mailing Address - Country:US
Mailing Address - Phone:720-224-8668
Mailing Address - Fax:
Practice Address - Street 1:201 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NM
Practice Address - Zip Code:88029
Practice Address - Country:US
Practice Address - Phone:575-544-5421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare