MEDICARE: TIFFANY 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	2355S0801X	Speech-Language Assistant	3586	CA

General Provider Information

NPI Number	:	1225563554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY TRUJILLO

Provider Business Mailing Address
First Line	:	355 REDONDO AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90814-2656
Country	:	US
Telephone Number	:	888-223-8002
Fax Number	:

Provider Business Practice Location Address
First Line	:	355 REDONDO AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90814-2656
Country	:	US
Telephone Number	:	888-223-8002
Fax Number	:

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

Provider Enumeration Date	:	04/24/2017
Last Update Date	:	03/17/2021

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Directions to “ TIFFANY TRUJILLO ” Practice Location

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