Healthcare Provider Details

I. General information

NPI: 1609310283
Provider Name (Legal Business Name): MARIA T. TRUJILLO DH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2016
Last Update Date: 08/02/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19969 GREENLEY RD STE D
SONORA CA
95370-5908
US

IV. Provider business mailing address

19969 GREENLEY RD STE D
SONORA CA
95370-5908
US

V. Phone/Fax

Practice location:
  • Phone: 209-532-0034
  • Fax:
Mailing address:
  • Phone: 209-532-0034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number28119
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: