Provider Demographics
NPI:1831219690
Name:TRUMBULL, JEFFREY HOWARD
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:HOWARD
Last Name:TRUMBULL
Suffix:
Gender:M
Credentials:
Other - Prefix:MRS
Other - First Name:KAY
Other - Middle Name:TERESE
Other - Last Name:TRUMBULL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4025 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-4703
Mailing Address - Country:US
Mailing Address - Phone:520-795-4646
Mailing Address - Fax:
Practice Address - Street 1:4025 E 17TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-4703
Practice Address - Country:US
Practice Address - Phone:520-795-4646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ124673747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant