Healthcare Provider Details

I. General information

NPI: 1831733757
Provider Name (Legal Business Name): ERNESTINE R TRUJILLO MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2019
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 CAMINO DE SALUD NE
ALBUQUERQUE NM
87102-4517
US

IV. Provider business mailing address

800 BRADBURY DR SE STE 116
ALBUQUERQUE NM
87106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 505-925-0181
  • Fax:
Mailing address:
  • Phone: 505-272-1476
  • Fax: 505-925-0100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number499
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code133VN1301X
TaxonomyOncology Nutrition Registered Dietitian
License Number499
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: