Healthcare Provider Details

I. General information

NPI: 1184555286
Provider Name (Legal Business Name): NICOLE TRUJILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 35TH AVE
OAKLAND CA
94601-3124
US

IV. Provider business mailing address

145 17TH ST APT 305
OAKLAND CA
94612-4680
US

V. Phone/Fax

Practice location:
  • Phone: 510-534-0282
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number9432210C94
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: