Provider Demographics
NPI:1265754477
Name:TRUJILLO, RAYMOND
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:TRUJILLO
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 1:1685 S DON ROSER DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4586
Mailing Address - Country:US
Mailing Address - Phone:575-541-4409
Mailing Address - Fax:575-541-4452
Practice Address - Street 1:1685 S DON ROSER DR
Practice Address - Street 2:SUITE D
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4586
Practice Address - Country:US
Practice Address - Phone:575-541-4409
Practice Address - Fax:575-541-4452
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-16
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM03-179647-00-8332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies