Healthcare Provider Details

I. General information

NPI: 1477862662
Provider Name (Legal Business Name): AMY J TRUJILLO ED.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 10/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PARK ST
BAYARD NM
88023
US

IV. Provider business mailing address

PO BOX 1000
BAYARD NM
88023
US

V. Phone/Fax

Practice location:
  • Phone: 575-537-4000
  • Fax: 575-537-3921
Mailing address:
  • Phone: 575-537-4000
  • Fax: 575-537-3921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number334946
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: