MEDICARE: KIMBERLY TRUYOL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	247200000X	Other Technician

General Provider Information

NPI Number	:	1154841138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY TRUYOL

Provider Business Mailing Address
First Line	:	4605 ALLEGHENY CT NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-3469
Country	:	US
Telephone Number	:	505-550-0821
Fax Number	:

Provider Business Practice Location Address
First Line	:	2305 SAN PEDRO DR NE STE D-1
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-4119
Country	:	US
Telephone Number	:	505-296-7800
Fax Number	:	505-296-7808

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2017
Last Update Date	:	06/21/2017

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Directions to “ KIMBERLY TRUYOL ” Practice Location

Language	Start Address	Practice Location

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