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General NPI Number Information
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NPI Number | 1699532838
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Entity Type | Individual
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Provider Name | MR. JESUS TRUJILLO RODRIGUEZ
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Gender | Male
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Dates
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Enumeration Date | 03/04/2024
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Last Update Date | 10/23/2025
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Provider Practice Location Address
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Address Line | 575 AUTO CENTER DR
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City | WATSONVILLE
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State | CA
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Zip | 95076-3727
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Country | US
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Telephone | 831-288-6537
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Fax | 831-722-2855
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Provider Business Mailing Address
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Address Line | 3400 DATA DR ATTENTION: CREDENTIALING AND PAYER ENROLLMENT DEPT
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City | RANCHO CORDOVA
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State | CA
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Zip | 95670
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 64725
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License Number State | CA
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