MEDICARE: BERTHA TRUJILLO

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
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1194290395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERTHA TRUJILLO

Provider Business Mailing Address
First Line	:	236 MADEIRA AVE APT 9
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-3959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	236 MADEIRA AVE APT 9
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-3959
Country	:	US
Telephone Number	:	786-327-6567
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2018
Last Update Date	:	10/04/2018

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