Provider Demographics
NPI:1013436971
Name:TRUJILLO ROMO, GUSTABO (MS)
Entity type:Individual
Prefix:
First Name:GUSTABO
Middle Name:
Last Name:TRUJILLO ROMO
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 GEER RD STE 120
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-2456
Mailing Address - Country:US
Mailing Address - Phone:209-664-8044
Mailing Address - Fax:209-664-8036
Practice Address - Street 1:2101 GEER RD STE 120
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2456
Practice Address - Country:US
Practice Address - Phone:209-664-8044
Practice Address - Fax:209-664-8036
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X, 372600000X
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator