Healthcare Provider Details

I. General information

NPI: 1508330192
Provider Name (Legal Business Name): ALICE TRUJILLO OLIVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 01/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3717 MT. PINOS WAY
FRAZIER PARK CA
93225
US

IV. Provider business mailing address

3105 WILSON RD
BAKERSFIELD CA
93304-5319
US

V. Phone/Fax

Practice location:
  • Phone: 661-245-0250
  • Fax: 661-245-0252
Mailing address:
  • Phone: 661-397-8775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: