Provider Demographics
NPI:1740660422
Name:TRUJILLO, REINALDO
Entity type:Individual
Prefix:
First Name:REINALDO
Middle Name:
Last Name:TRUJILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 S PINE ISLAND RD
Mailing Address - Street 2:APT 219
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2635
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 S PINE ISLAND RD
Practice Address - Street 2:APT 219
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2635
Practice Address - Country:US
Practice Address - Phone:754-245-8323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLOS14274207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program