Provider Demographics
NPI:1679013924
Name:TRUJILLO, JORDAN RANI (LMP)
Entity Type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:RANI
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:RANI
Other - Last Name:PATTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8214 185TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-2461
Mailing Address - Country:US
Mailing Address - Phone:253-759-1500
Mailing Address - Fax:253-759-4172
Practice Address - Street 1:2611 N STEVENS ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-4670
Practice Address - Country:US
Practice Address - Phone:253-759-1500
Practice Address - Fax:253-759-4172
Is Sole Proprietor?:No
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60730301225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist