Provider Demographics
NPI:1457148454
Name:TRUJILLO, MALERIE FAITH
Entity type:Individual
Prefix:
First Name:MALERIE
Middle Name:FAITH
Last Name:TRUJILLO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:MALERIE
Other - Middle Name:DANELLA
Other - Last Name:CDE BACA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 COUNTRY CLUB DR SE APT C105
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-5830
Mailing Address - Country:US
Mailing Address - Phone:505-401-7989
Mailing Address - Fax:
Practice Address - Street 1:900 COUNTRY CLUB DR SE APT C105
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-5830
Practice Address - Country:US
Practice Address - Phone:505-401-7989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician