Provider Demographics
NPI:1396915872
Name:TRUJILLO, KRISTINA ANN BRADLEY (PHD)
Entity type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:ANN BRADLEY
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:TINA
Other - Middle Name:BRADLEY
Other - Last Name:TRUJILLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1151 EL CENTRO ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-5721
Mailing Address - Country:US
Mailing Address - Phone:818-635-3879
Mailing Address - Fax:
Practice Address - Street 1:1151 EL CENTRO ST
Practice Address - Street 2:SUITE B
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-5721
Practice Address - Country:US
Practice Address - Phone:818-635-3879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23784103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical