Provider Demographics
NPI:1710131727
Name:TRUJILLO, THOMAS ALLEN JR (APCC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:ALLEN
Last Name:TRUJILLO
Suffix:JR
Gender:M
Credentials:APCC
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 172
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-0017
Mailing Address - Country:US
Mailing Address - Phone:707-235-7313
Mailing Address - Fax:
Practice Address - Street 1:1625 CARROLL AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94124-3219
Practice Address - Country:US
Practice Address - Phone:415-468-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA480015BP101YA0400X
CA00000529101YM0800X
CAAPCC13690101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health