Healthcare Provider Details

I. General information

NPI: 1770678963
Provider Name (Legal Business Name): MRS. KATHLEEN LOUISA TRUJILLO CHING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. KATHLEEN LOUISA TRUJILLO

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SAN PEDRO SE
ALBUQUERQUE NM
87108
US

IV. Provider business mailing address

3404 SHADOW MEADOWS DR
RIO RANCHO NM
87144
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-1711
  • Fax:
Mailing address:
  • Phone: 505-896-1869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: