Healthcare Provider Details

I. General information

NPI: 1972642171
Provider Name (Legal Business Name): CARLOS ALBERTO TRUJILLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 MEDICAL CENTER BLVD SUITE N-813
MARRERO LA
70072-3151
US

IV. Provider business mailing address

1111 MEDICAL CENTER BLVD SUITE N-813
MARRERO LA
70072-3151
US

V. Phone/Fax

Practice location:
  • Phone: 504-349-6813
  • Fax: 504-319-6832
Mailing address:
  • Phone: 504-349-6813
  • Fax: 504-319-6832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number06128R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: