Provider Demographics
NPI:1912999376
Name:TRUJILLO MEDICAL THERAPY GROUP
Entity Type:Organization
Organization Name:TRUJILLO MEDICAL THERAPY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:NILMA
Authorized Official - Middle Name:E
Authorized Official - Last Name:LUGO-MARCHANY
Authorized Official - Suffix:
Authorized Official - Credentials:MPT,PT
Authorized Official - Phone:787-283-2170
Mailing Address - Street 1:PO BOX 1892
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-1892
Mailing Address - Country:US
Mailing Address - Phone:787-283-2170
Mailing Address - Fax:787-283-2170
Practice Address - Street 1:TRUJILLO ALTO PLZ
Practice Address - Street 2:TRUJILLO MEDICAL, SUITE 201
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-3600
Practice Address - Country:US
Practice Address - Phone:787-283-2170
Practice Address - Fax:787-283-2170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR303261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR89967Medicare ID - Type Unspecified