Provider Demographics
NPI:1962647347
Name:VIRAMONTES TRUJILLO, LETICIA
Entity Type:Individual
Prefix:MRS
First Name:LETICIA
Middle Name:
Last Name:VIRAMONTES TRUJILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E NARRAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-2632
Mailing Address - Country:US
Mailing Address - Phone:623-327-2284
Mailing Address - Fax:623-386-9705
Practice Address - Street 1:1000 E NARRAMORE AVE
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-2632
Practice Address - Country:US
Practice Address - Phone:623-327-2284
Practice Address - Fax:623-386-9705
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-12
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide