Provider Demographics
NPI:1184245292
Name:TRUJILLO ARVIZU, LUIS GERMAN
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:GERMAN
Last Name:TRUJILLO ARVIZU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 NW 12TH AVENUE
Mailing Address - Street 2:CENTRAL 600-D
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136
Mailing Address - Country:US
Mailing Address - Phone:305-585-2515
Mailing Address - Fax:305-585-8137
Practice Address - Street 1:1611 NW 12TH AVENUE
Practice Address - Street 2:CENTRAL 600-D
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136
Practice Address - Country:US
Practice Address - Phone:305-585-2515
Practice Address - Fax:305-585-8137
Is Sole Proprietor?:No
Enumeration Date:2020-04-29
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program