Healthcare Provider Details

I. General information

NPI: 1427364629
Provider Name (Legal Business Name): MORAIMA TRUJILLO MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 08/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 N GREENWAY DR
CORAL GABLES FL
33134-4759
US

IV. Provider business mailing address

1015 N GREENWAY DR
CORAL GABLES FL
33134-4759
US

V. Phone/Fax

Practice location:
  • Phone: 305-389-6822
  • Fax: 305-774-6030
Mailing address:
  • Phone: 305-389-6822
  • Fax: 305-774-6030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MORAIMA TRUJILLO
Title or Position: PRESIDENT
Credential: MD
Phone: 305-389-6822