Provider Demographics
NPI:1619862901
Name:TRUJILLO, MYRNA JANELLE
Entity type:Individual
Prefix:
First Name:MYRNA
Middle Name:JANELLE
Last Name:TRUJILLO
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 1:309 N FILLMORE AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-5617
Mailing Address - Country:US
Mailing Address - Phone:909-471-9140
Mailing Address - Fax:
Practice Address - Street 1:237 N RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-5923
Practice Address - Country:US
Practice Address - Phone:877-323-4283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician