Healthcare Provider Details

I. General information

NPI: 1346339900
Provider Name (Legal Business Name): JORGE MARIO TRUJILLO MD,PHD,MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 CARILLON PKWY SUITE 103
ST PETERSBURG FL
33716-1115
US

IV. Provider business mailing address

6914 AQUEDUCT TER
ODESSA FL
33556-1867
US

V. Phone/Fax

Practice location:
  • Phone: 727-556-2662
  • Fax:
Mailing address:
  • Phone: 813-792-1273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberME 80621
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: