Provider Demographics
NPI:1790946879
Name:TRUJILLO, DANIEL (PHD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:TRUJILLO
Suffix:
Gender:M
Credentials:PHD
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 402
Mailing Address - Street 2:6659 E 400 N
Mailing Address - City:ROLLING PRAIRIE
Mailing Address - State:IN
Mailing Address - Zip Code:46371-0402
Mailing Address - Country:US
Mailing Address - Phone:219-778-9209
Mailing Address - Fax:
Practice Address - Street 1:6659 E 400 N
Practice Address - Street 2:
Practice Address - City:ROLLING PRAIRIE
Practice Address - State:IN
Practice Address - Zip Code:46371-9650
Practice Address - Country:US
Practice Address - Phone:219-778-9209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040269A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical