Healthcare Provider Details

I. General information

NPI: 1083375372
Provider Name (Legal Business Name): JORGE LUIS TRUJILLO II NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2022
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1983 MARENGO ST
LOS ANGELES CA
90033-1370
US

IV. Provider business mailing address

1983 MARENGO ST
LOS ANGELES CA
90033-1370
US

V. Phone/Fax

Practice location:
  • Phone: 310-692-1422
  • Fax:
Mailing address:
  • Phone: 310-692-1422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95032631
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95251230
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: