Healthcare Provider Details

I. General information

NPI: 1215101415
Provider Name (Legal Business Name): LUCIANNA TRUJILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 05/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 N. CENTRO FAMILAR SW
ALBUQUERQUE NM
87105
US

IV. Provider business mailing address

2713 CAGUA DR NE
ALBUQUERQUE NM
87110-3219
US

V. Phone/Fax

Practice location:
  • Phone: 505-873-7400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD2010-0751
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: