Healthcare Provider Details

I. General information

NPI: 1821702325
Provider Name (Legal Business Name): SANTA TRUJILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 E 25TH ST
LOS ANGELES CA
90011-1707
US

IV. Provider business mailing address

1227 E 25TH ST
LOS ANGELES CA
90011-1707
US

V. Phone/Fax

Practice location:
  • Phone: 323-926-7454
  • Fax:
Mailing address:
  • Phone: 323-926-7454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: