Healthcare Provider Details

I. General information

NPI: 1164531950
Provider Name (Legal Business Name): JONATHAN NEIL TRUJILLO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 40
SAN FIDEL NM
87049-0040
US

IV. Provider business mailing address

9999 RADCLIFFE RD NW
ALBUQUERQUE NM
87114-4410
US

V. Phone/Fax

Practice location:
  • Phone: 505-552-5394
  • Fax:
Mailing address:
  • Phone: 505-717-5354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRP00006615
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPC00000151
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: