Provider Demographics
NPI:1477658615
Name:TRUITT, EHRLAND AKASHA (DOM)
Entity type:Individual
Prefix:DR
First Name:EHRLAND
Middle Name:AKASHA
Last Name:TRUITT
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 LA PLACITA CIR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4009
Mailing Address - Country:US
Mailing Address - Phone:505-820-8786
Mailing Address - Fax:
Practice Address - Street 1:2003 HOPI RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2401
Practice Address - Country:US
Practice Address - Phone:505-820-8786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM692171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM00RG65OtherBLUE CROSS/BLUE SHIELD ID