Healthcare Provider Details

I. General information

NPI: 1538589973
Provider Name (Legal Business Name): ROSSANA TRUJILLO LBSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 04/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 S SILVER AVE
DEMING NM
88030-3715
US

IV. Provider business mailing address

215 S SILVER AVE
DEMING NM
88030-3715
US

V. Phone/Fax

Practice location:
  • Phone: 575-546-9605
  • Fax: 575-546-9427
Mailing address:
  • Phone: 575-546-9605
  • Fax: 575-546-9427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1241
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: