Provider Demographics
NPI:1831733757
Name:TRUJILLO, ERNESTINE R (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:ERNESTINE
Middle Name:R
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BRADBURY DR SE STE 116
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4310
Mailing Address - Country:US
Mailing Address - Phone:505-272-1476
Mailing Address - Fax:505-925-0100
Practice Address - Street 1:1201 CAMINO DE SALUD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-4517
Practice Address - Country:US
Practice Address - Phone:505-925-0181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-04
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM499133V00000X, 133VN1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1301XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, OncologyGroup - Single Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered