Provider Demographics
NPI:1619342011
Name:RAYMOND TRUJILLO
Entity Type:Organization
Organization Name:RAYMOND TRUJILLO
Other - Org Name:ADVANTAGE MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUJILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-541-4409
Mailing Address - Street 1:1685 S DON ROSER DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4586
Mailing Address - Country:US
Mailing Address - Phone:575-541-4409
Mailing Address - Fax:575-541-4452
Practice Address - Street 1:1685 S DON ROSER DR
Practice Address - Street 2:SUITE D
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4586
Practice Address - Country:US
Practice Address - Phone:575-541-4409
Practice Address - Fax:575-541-4452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM03179647008332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies