Provider Demographics
NPI:1669407698
Name:TRUJILLO, MARY E (CNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 WALTER ST NE, STE 401
Mailing Address - Street 2:LOVELACE NEUROSCIENCE CENTER
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2563
Mailing Address - Country:US
Mailing Address - Phone:505-727-5910
Mailing Address - Fax:
Practice Address - Street 1:PMG CEDAR NEUROSURGERY
Practice Address - Street 2:201 CEDAR SE
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106
Practice Address - Country:US
Practice Address - Phone:505-563-6399
Practice Address - Fax:505-563-6680
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMR32902103TP0814X
NMCNP00677363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM83251065Medicaid
349733202Medicare PIN
Q38451Medicare UPIN