Provider Demographics
NPI:1851805097
Name:TRUJILLO, SERGIO ALEJANDRO
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:ALEJANDRO
Last Name:TRUJILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 E BONANZA RD STE 160
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-3705
Mailing Address - Country:US
Mailing Address - Phone:702-771-9128
Mailing Address - Fax:702-527-7922
Practice Address - Street 1:3020 E BONANZA RD STE 160
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-3705
Practice Address - Country:US
Practice Address - Phone:702-771-9128
Practice Address - Fax:702-527-7922
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty