Provider Demographics
NPI:1992036172
Name:TRUJILLO, JOSE LUIS (MFTT)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:LUIS
Last Name:TRUJILLO
Suffix:
Gender:M
Credentials:MFTT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94561-3302
Mailing Address - Country:US
Mailing Address - Phone:925-776-8200
Mailing Address - Fax:925-776-8260
Practice Address - Street 1:2021 MAIN ST
Practice Address - Street 2:
Practice Address - City:OAKLEY
Practice Address - State:CA
Practice Address - Zip Code:94561-3302
Practice Address - Country:US
Practice Address - Phone:925-776-8200
Practice Address - Fax:925-776-8260
Is Sole Proprietor?:No
Enumeration Date:2010-01-27
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA64499101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist