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General NPI Number Information
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NPI Number | 1265932107
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Entity Type | Individual
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Provider Name | CRYSTAL TRUJILLO
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Gender | Female
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Dates
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Enumeration Date | 02/16/2018
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Last Update Date | 05/30/2023
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Provider Practice Location Address
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Address Line | 1212 N SAN DIMAS CANYON RD
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City | SAN DIMAS
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State | CA
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Zip | 91773-1223
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Country | US
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Telephone | 626-628-1204
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Fax |
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Provider Business Mailing Address
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Address Line | 2151 E CONVENTION CENTER WAY STE 103
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City | ONTARIO
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State | CA
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Zip | 91764-5449
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-22-58047
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License Number State | CA
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