Healthcare Provider Details

I. General information

NPI: 1760548101
Provider Name (Legal Business Name): DANIELLE D TRUJILLO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5321 MENAUL BLVD NE STE A
ALBUQUERQUE NM
87110-3127
US

IV. Provider business mailing address

PO BOX 37440
ALBUQUERQUE NM
87176-7440
US

V. Phone/Fax

Practice location:
  • Phone: 505-889-3412
  • Fax: 505-889-3422
Mailing address:
  • Phone: 505-889-3412
  • Fax: 505-889-3422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberM05227
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: