Healthcare Provider Details

I. General information

NPI: 1548195449
Provider Name (Legal Business Name): ANDRES HECTOR TRUJILLO D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 W HOLT AVE
POMONA CA
91768-3308
US

IV. Provider business mailing address

1575 S RESERVOIR ST APT A
POMONA CA
91766-5473
US

V. Phone/Fax

Practice location:
  • Phone: 909-623-9590
  • Fax:
Mailing address:
  • Phone: 909-668-9509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113032
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: