Provider Demographics
NPI:1295952893
Name:TRUJEQUE, KATHY MARIE
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:MARIE
Last Name:TRUJEQUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 QUANDT PL # B
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245-2045
Mailing Address - Country:US
Mailing Address - Phone:559-925-9972
Mailing Address - Fax:
Practice Address - Street 1:122 QUANDT PLACE # B
Practice Address - Street 2:
Practice Address - City:LEMOORE
Practice Address - State:CA
Practice Address - Zip Code:93245
Practice Address - Country:US
Practice Address - Phone:559-935-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)