Healthcare Provider Details

I. General information

NPI: 1043281744
Provider Name (Legal Business Name): CESAR REZA-TRUJILLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 W 54TH ST FL 8
NEW YORK NY
10019-3545
US

IV. Provider business mailing address

3822 COPPER BEND RD
LAREDO TX
78045-8440
US

V. Phone/Fax

Practice location:
  • Phone: 212-889-3142
  • Fax:
Mailing address:
  • Phone: 956-740-7392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberL2595
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number315335
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: