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General NPI Number Information
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NPI Number | 1801029962
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Entity Type | Individual
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Provider Name | NOEL TRUJILLO CSA
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Gender | Male
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Dates
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Enumeration Date | 08/24/2009
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Last Update Date | 08/24/2009
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Provider Practice Location Address
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Address Line | 3661 S MIAMI AVE SUITE 708
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City | MIAMI
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State | FL
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Zip | 33133-4236
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Country | US
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Telephone | 305-251-3991
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Fax | 305-251-7982
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Provider Business Mailing Address
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Address Line | 3661 S MIAMI AVE SUITE 708
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City | MIAMI
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State | FL
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Zip | 33133-4236
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Country | US
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Telephone | 305-251-3991
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Fax | 305-251-7982
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | HSE12042
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License Number State | FL
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