Healthcare Provider Details

I. General information

NPI: 1972564292
Provider Name (Legal Business Name): MARK TRUJILLO SURGICAL ASSISTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

788 S 10TH AVE
BRIGHTON CO
80601-3237
US

IV. Provider business mailing address

PO BOX 362
BRIGHTON CO
80601-0362
US

V. Phone/Fax

Practice location:
  • Phone: 303-890-2015
  • Fax:
Mailing address:
  • Phone: 303-890-2015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License NumberCERTIFICATION F01493
License Number StateCO

VIII. Authorized Official

Name: MR. MARK TRUJILLO
Title or Position: OWNER
Credential: CST/CFA
Phone: 303-890-2015