Healthcare Provider Details

I. General information

NPI: 1033759402
Provider Name (Legal Business Name): ALEJANDRO TRUJILLO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2208 W COLUMBIA AVE
KISSIMMEE FL
34741-3436
US

IV. Provider business mailing address

2208 W COLUMBIA AVE
KISSIMMEE FL
34741-3436
US

V. Phone/Fax

Practice location:
  • Phone: 407-201-6255
  • Fax: 407-201-7195
Mailing address:
  • Phone: 305-879-3408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: