Healthcare Provider Details

I. General information

NPI: 1588136402
Provider Name (Legal Business Name): ADRIANA TRUJILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2018
Last Update Date: 12/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6245 N FRESNO ST
FRESNO CA
93710-5270
US

IV. Provider business mailing address

945 2ND ST
SANGER CA
93657-2157
US

V. Phone/Fax

Practice location:
  • Phone: 559-554-9999
  • Fax:
Mailing address:
  • Phone: 559-344-7912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number90822
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: