Healthcare Provider Details

I. General information

NPI: 1619342011
Provider Name (Legal Business Name): RAYMOND TRUJILLO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2015
Last Update Date: 12/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1685 S DON ROSER DR SUITE D
LAS CRUCES NM
88011-4586
US

IV. Provider business mailing address

1685 S DON ROSER DR SUITE D
LAS CRUCES NM
88011-4586
US

V. Phone/Fax

Practice location:
  • Phone: 575-541-4409
  • Fax: 575-541-4452
Mailing address:
  • Phone: 575-541-4409
  • Fax: 575-541-4452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number03179647008
License Number StateNM

VIII. Authorized Official

Name: RAYMOND TRUJILLO
Title or Position: OWNER
Credential:
Phone: 575-541-4409