Healthcare Provider Details

I. General information

NPI: 1245833607
Provider Name (Legal Business Name): MICHAEL JOSEPH TRUJILLO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2020
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3048 E BASELINE RD STE 101
MESA AZ
85204-7287
US

IV. Provider business mailing address

3048 E BASELINE RD STE 101
MESA AZ
85204-7287
US

V. Phone/Fax

Practice location:
  • Phone: 520-231-7380
  • Fax: 707-635-8215
Mailing address:
  • Phone: 520-231-7380
  • Fax: 707-635-8215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBEH-001997
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: