Provider Demographics
NPI:1770897134
Name:ALARCON DE TRUJILLO, JESSIE (LMT)
Entity type:Individual
Prefix:MRS
First Name:JESSIE
Middle Name:
Last Name:ALARCON DE TRUJILLO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 CONITA REAL AVE SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-4013
Mailing Address - Country:US
Mailing Address - Phone:505-247-2500
Mailing Address - Fax:
Practice Address - Street 1:500 OAK ST NE
Practice Address - Street 2:SUITE 216
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4738
Practice Address - Country:US
Practice Address - Phone:505-247-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5036225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist