Provider Demographics
NPI:1942063268
Name:TRUJILLO, ALBERTO GABRIEL (PEER SPECIALIST)
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:GABRIEL
Last Name:TRUJILLO
Suffix:
Gender:M
Credentials:PEER SPECIALIST
Other - Prefix:
Other - First Name:GABRIEL
Other - Middle Name:
Other - Last Name:TRUJILLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:111 DURAN DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-2317
Mailing Address - Country:US
Mailing Address - Phone:415-996-4236
Mailing Address - Fax:
Practice Address - Street 1:3270 KERNER BLVD STE C
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-4840
Practice Address - Country:US
Practice Address - Phone:415-457-4552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist