Healthcare Provider Details

I. General information

NPI: 1730738568
Provider Name (Legal Business Name): HECTOR TRUJILLO ND, LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2019
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22113 MONETA AVE
CARSON CA
90745-2816
US

IV. Provider business mailing address

22113 MONETA AVE
CARSON CA
90745-2816
US

V. Phone/Fax

Practice location:
  • Phone: 714-336-0601
  • Fax:
Mailing address:
  • Phone: 714-336-0601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number19072
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: