Healthcare Provider Details

I. General information

NPI: 1679351696
Provider Name (Legal Business Name): KATHRYN TRUJILLO M.A., MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2023
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10735 W 12TH LN APT 4
LAKEWOOD CO
80215-4562
US

IV. Provider business mailing address

10735 W 12TH LN APT 4
LAKEWOOD CO
80215-4562
US

V. Phone/Fax

Practice location:
  • Phone: 510-926-0653
  • Fax:
Mailing address:
  • Phone: 510-926-0653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number17335
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: