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NPI Code Detail

MEDICARE: MR. JESSE ERNEST TRUJILLO

MEDICARE: MR. JESSE ERNEST TRUJILLO
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1790962991
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JESSE ERNEST TRUJILLO
Provider Business Mailing Address
First Line : 4974 EL CAJON BLVD
Second Line : SUITE A
City : SAN DIEGO
State : CA
Zip : 92115-4677
Country : US
Telephone Number : 619-286-4600
Fax Number :
Provider Business Practice Location Address
First Line : 4974 EL CAJON BLVD
Second Line : SUITE A
City : SAN DIEGO
State : CA
Zip : 92115-4677
Country : US
Telephone Number : 619-286-4600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2008
Last Update Date : 01/30/2008

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Directions to “ MR. JESSE ERNEST TRUJILLO ” Practice Location

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