Provider Demographics
NPI:1912519034
Name:TRUJILLO, NANCY MARITZA
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:MARITZA
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 W FOOTHILL BLVD APT 20D
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-1169
Mailing Address - Country:US
Mailing Address - Phone:626-756-2048
Mailing Address - Fax:
Practice Address - Street 1:150 W FOOTHILL BLVD APT 20D
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-1169
Practice Address - Country:US
Practice Address - Phone:626-756-2048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1382500420101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)