Healthcare Provider Details

I. General information

NPI: 1841887502
Provider Name (Legal Business Name): ROBERTO JAIME TRUJILLO AGACNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2020
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11130 CHRISTUS HLS STE 207
SAN ANTONIO TX
78251-3586
US

IV. Provider business mailing address

11130 CHRISTUS HLS STE 207
SAN ANTONIO TX
78251-3586
US

V. Phone/Fax

Practice location:
  • Phone: 210-228-0044
  • Fax: 210-228-0045
Mailing address:
  • Phone: 210-228-0044
  • Fax: 210-228-0045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1020434
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: