Healthcare Provider Details

I. General information

NPI: 1073755567
Provider Name (Legal Business Name): LOUIS ALEXANDER TRUJILLO CSA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2009
Last Update Date: 10/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 W 61ST PL
HIALEAH FL
33012-6314
US

IV. Provider business mailing address

7000 NW 186TH ST APT 4-114
MIAMI GARDENS FL
33015-3121
US

V. Phone/Fax

Practice location:
  • Phone: 305-725-7202
  • Fax:
Mailing address:
  • Phone: 305-721-0082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number#CSA3797
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: