Healthcare Provider Details

I. General information

NPI: 1922556182
Provider Name (Legal Business Name): DR. WILLIAM BRETT TRUJILLO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2016
Last Update Date: 09/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N BULLARD AVE C27
GOODYEAR AZ
85338-2533
US

IV. Provider business mailing address

500 N BULLARD AVE C27
GOODYEAR AZ
85338-2533
US

V. Phone/Fax

Practice location:
  • Phone: 623-986-5110
  • Fax:
Mailing address:
  • Phone: 623-986-5110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10218PT
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: