Provider Demographics
NPI:1639963200
Name:TRUJILLO, ERICA
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:TRUJILLO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5824 S MCVICKER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-3536
Mailing Address - Country:US
Mailing Address - Phone:312-792-0081
Mailing Address - Fax:
Practice Address - Street 1:913 W WELLINGTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6709
Practice Address - Country:US
Practice Address - Phone:872-843-0200
Practice Address - Fax:872-843-9000
Is Sole Proprietor?:No
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program