=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912996331
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HECTOR TRUJILLO MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2005
-----------------------------------------------------
Last Update Date | 02/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5901 SW 74TH ST STE 312
-----------------------------------------------------
City | SOUTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33143-5165
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-665-5808
-----------------------------------------------------
Fax | 888-571-6329
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5901 SW 74TH ST STE 312
-----------------------------------------------------
City | SOUTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33143-5165
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-665-5808
-----------------------------------------------------
Fax | 888-571-6329
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | ME81526
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------