Healthcare Provider Details

I. General information

NPI: 1568303238
Provider Name (Legal Business Name): FABIOLA BEATRIZ TRUJILLO RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2026
Last Update Date: 04/04/2026
Certification Date: 04/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1899 TATE BLVD SE # 2110
HICKORY NC
28602-4200
US

IV. Provider business mailing address

314 BEACON HILLS DR
GASTONIA NC
28056-8369
US

V. Phone/Fax

Practice location:
  • Phone: 828-328-4449
  • Fax:
Mailing address:
  • Phone: 980-339-2332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5024270
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: