Healthcare Provider Details

I. General information

NPI: 1588924534
Provider Name (Legal Business Name): MRS. KAREN B TRUJILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 05/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9127 SANTA CATALINA AVE NW
ALBUQUERQUE NM
87121-7876
US

IV. Provider business mailing address

2612 TEXAS ST NE
ALBUQUERQUE NM
87110-4684
US

V. Phone/Fax

Practice location:
  • Phone: 505-414-3054
  • Fax:
Mailing address:
  • Phone: 505-414-3054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: