Provider Demographics
NPI:1922067545
Name:TRUNZO, LOUIS GERARD (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:GERARD
Last Name:TRUNZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14045 N 7TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-4387
Mailing Address - Country:US
Mailing Address - Phone:602-482-7311
Mailing Address - Fax:602-482-7314
Practice Address - Street 1:14045 N 7TH ST STE 2
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-4387
Practice Address - Country:US
Practice Address - Phone:602-482-7311
Practice Address - Fax:602-482-7314
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19585208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ001529OtherAHCCCS
AZ001529Medicaid
F83044Medicare UPIN
AZWMBDL01Medicare ID - Type Unspecified
AZ001529Medicaid