Provider Demographics
NPI:1891857298
Name:TRUJILLO, SEAN CASTRO (MPT)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:CASTRO
Last Name:TRUJILLO
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1138 N CHINOWTH ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-4113
Mailing Address - Country:US
Mailing Address - Phone:559-713-1222
Mailing Address - Fax:
Practice Address - Street 1:1138 N CHINOWTH ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-4113
Practice Address - Country:US
Practice Address - Phone:559-713-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT21334225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT213340OtherBLUE SHIELD INDIVID PROV
CAOPT213341Medicare ID - Type UnspecifiedMEDICARE PPIN