Healthcare Provider Details

I. General information

NPI: 1689553968
Provider Name (Legal Business Name): ANTHONY TRUJILLO LPTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2025
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 MISSION AVE STE 7
OCEANSIDE CA
92058-7801
US

IV. Provider business mailing address

4776 CALLE ESTRELLA
OCEANSIDE CA
92057-5903
US

V. Phone/Fax

Practice location:
  • Phone: 760-547-2854
  • Fax: 877-298-4204
Mailing address:
  • Phone: 760-681-8721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number54306
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: