{
"Npi": {
"NPI": "1073843413",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "TRUJILLO",
"FirstName": "NATHAN",
"MiddleName": null,
"NamePrefix": "MR.",
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1950 S SUNWEST LN STE 200",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAN BERNARDINO",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92408-3248",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "909-252-4044",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "44750 60TH ST W",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LANCASTER",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "93536-7619",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "760-228-6391",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/07/2010",
"LastUpdateDate": "08/28/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": "06/09/2014",
"NPIReactivationDate": "04/25/2023",
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "104100000X",
"TaxonomyName": "Social Worker",
"LicenseNumber": "AWS125596",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "390200000X",
"TaxonomyName": "Student in an Organized Health Care Education/Training Program",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}