Healthcare Provider Details

I. General information

NPI: 1164369708
Provider Name (Legal Business Name): BROOKE TRUJLLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E MADRID AVE APT H8
LAS CRUCES NM
88001-1980
US

IV. Provider business mailing address

1500 E MADRID AVE APT H8
LAS CRUCES NM
88001-1980
US

V. Phone/Fax

Practice location:
  • Phone: 575-932-8930
  • Fax:
Mailing address:
  • Phone: 575-932-8930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number2048
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: