Healthcare Provider Details

I. General information

NPI: 1154599009
Provider Name (Legal Business Name): SARITA TRUJILLO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 GUACHPANGUE RD
ESPANOLA NM
87532-3424
US

IV. Provider business mailing address

PO BOX 1011
CHIMAYO NM
87522-1011
US

V. Phone/Fax

Practice location:
  • Phone: 505-747-8187
  • Fax:
Mailing address:
  • Phone: 505-901-9516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberL20045
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN67107
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: