Healthcare Provider Details

I. General information

NPI: 1295952893
Provider Name (Legal Business Name): KATHY MARIE TRUJEQUE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 QUANDT PLACE # B
LEMOORE CA
93245
US

IV. Provider business mailing address

122 QUANDT PL # B
LEMOORE CA
93245-2045
US

V. Phone/Fax

Practice location:
  • Phone: 559-935-4900
  • Fax:
Mailing address:
  • Phone: 559-925-9972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: