Healthcare Provider Details

I. General information

NPI: 1659692614
Provider Name (Legal Business Name): JASON ERIC TRUJILLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JASON ERIC JAETAO

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 10/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LOMAS BLVD NE 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87106-2745
US

IV. Provider business mailing address

2211 LOMAS BLVD NE
ALBUQUERQUE NM
87106-2719
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-4865
  • Fax:
Mailing address:
  • Phone: 505-999-8071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD2014-0752
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: