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NPI Code Detail

MEDICARE: JUAN TRUJILLO CUEVAS JR. SUDRC I 25243

MEDICARE: JUAN TRUJILLO CUEVAS JR. SUDRC I 25243
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor25243CA

General Provider Information

NPI Number : 1164368114
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUAN TRUJILLO CUEVAS JR. SUDRC I 25243
Provider Business Mailing Address
First Line : 242 W 14TH ST
Second Line :
City : SAN PEDRO
State : CA
Zip : 90731-4315
Country : US
Telephone Number : 424-339-7018
Fax Number :
Provider Business Practice Location Address
First Line : 2521 LONG BEACH AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90058-1324
Country : US
Telephone Number : 213-529-0963
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2026
Last Update Date : 04/23/2026

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