Healthcare Provider Details

I. General information

NPI: 1710131727
Provider Name (Legal Business Name): THOMAS ALLEN TRUJILLO JR. APCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 CARROLL AVE
SAN FRANCISCO CA
94124-3219
US

IV. Provider business mailing address

PO BOX 172
FAIRFIELD CA
94533-0017
US

V. Phone/Fax

Practice location:
  • Phone: 415-468-5100
  • Fax:
Mailing address:
  • Phone: 707-235-7313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number480015BP
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number00000529
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC13690
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: