Provider Demographics
NPI:1245362607
Name:TRUJILLO, MARCIA H (LMT)
Entity type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:H
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 S AVENUE C
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-7207
Mailing Address - Country:US
Mailing Address - Phone:505-226-0045
Mailing Address - Fax:
Practice Address - Street 1:2905 N PRINCE ST STE C
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-3843
Practice Address - Country:US
Practice Address - Phone:505-714-4395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5327225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00RE88OtherBLUE CROSS BLUE SHIELD