Healthcare Provider Details

I. General information

NPI: 1992229751
Provider Name (Legal Business Name): NATASHA LYNN TRUJILLO RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 STUTZ DR NE
ALBUQUERQUE NM
87112-6232
US

IV. Provider business mailing address

1201 STUTZ DR NE
ALBUQUERQUE NM
87112-6232
US

V. Phone/Fax

Practice location:
  • Phone: 505-720-6310
  • Fax:
Mailing address:
  • Phone: 505-720-6310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH4322
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: