Healthcare Provider Details

I. General information

NPI: 1548879737
Provider Name (Legal Business Name): SHILOH TRUJILLO SUDCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 12/24/2025
Certification Date: 12/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 APPLE ST STE 3
OCEANSIDE CA
92054-4455
US

IV. Provider business mailing address

1905 APPLE ST STE 3
OCEANSIDE CA
92054-4455
US

V. Phone/Fax

Practice location:
  • Phone: 760-547-1280
  • Fax: 760-547-1268
Mailing address:
  • Phone: 760-547-1280
  • Fax: 760-547-1268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number12368
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: