Healthcare Provider Details

I. General information

NPI: 1891373239
Provider Name (Legal Business Name): DANIEL TRUJILLO DIAZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S CHIPETA WAY
SALT LAKE CITY UT
84108-1222
US

IV. Provider business mailing address

501 S CHIPETA WAY
SALT LAKE CITY UT
84108-1222
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-7951
  • Fax:
Mailing address:
  • Phone: 801-581-7951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number73925
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: