Healthcare Provider Details

I. General information

NPI: 1225968100
Provider Name (Legal Business Name): JAN TRUJILLO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12361 LEWIS ST STE 204
GARDEN GROVE CA
92840-4677
US

IV. Provider business mailing address

7141 WOODLEY AVE
VAN NUYS CA
91406-3932
US

V. Phone/Fax

Practice location:
  • Phone: 818-285-8252
  • Fax: 818-273-1831
Mailing address:
  • Phone: 818-285-8252
  • Fax: 818-273-1831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: