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General NPI Number Information
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NPI Number | 1407185234
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Entity Type | Organization
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Legal Business Name | GERMAN A TRUJILLO DDS DENTAL CORPORATION
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Dates
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Enumeration Date | 12/07/2009
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 4520 EXECUTIVE DR STE 220
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City | SAN DIEGO
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State | CA
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Zip | 92121-3020
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Country | US
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Telephone | 858-434-7554
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Fax | 858-597-1005
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Provider Business Mailing Address
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Address Line | 4520 EXECUTIVE DR STE 220
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City | SAN DIEGO
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State | CA
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Zip | 92121-3020
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Country | US
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Telephone | 858-434-7554
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Fax | 858-597-1005
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Authorized Official
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Title or Position | OWNER
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Name | GERMAN TRUJILLO
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Credential |
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Telephone | 619-204-7722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 57008
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License Number State | CA
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