Healthcare Provider Details

I. General information

NPI: 1083355531
Provider Name (Legal Business Name): COREY HENDERSON TRUJILLO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COREY HENDERSON

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 NE 139TH ST
VANCOUVER WA
98686-2742
US

IV. Provider business mailing address

PO BOX 2077
PORTLAND OR
97208-2077
US

V. Phone/Fax

Practice location:
  • Phone: 360-487-1168
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOP61459020
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: