Healthcare Provider Details

I. General information

NPI: 1235083767
Provider Name (Legal Business Name): STORMY GAIL TRUJILLO LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

283 NW MILLER AVE
GRESHAM OR
97030-7260
US

IV. Provider business mailing address

20699 NE GLISAN ST APT 134
FAIRVIEW OR
97024-3842
US

V. Phone/Fax

Practice location:
  • Phone: 503-333-1205
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number29442
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: