MEDICARE: TRUJILLO ABA LLC

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1245183524
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRUJILLO ABA LLC

Provider Business Mailing Address
First Line	:	4783 MIRAGE BAY CIR UNIT 212
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33966-6649
Country	:	US
Telephone Number	:	786-367-4588
Fax Number	:

Provider Business Practice Location Address
First Line	:	4783 MIRAGE BAY CIR UNIT 212
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33966-6649
Country	:	US
Telephone Number	:	786-367-4588
Fax Number	:

Authorized Official
Title or Position	:	CEO / ADMINISTRATOR
Name	:	MICHELLE RUIZANCHEZ
Credential	:
Telephone Number	:	786-367-4588

Provider Enumeration Date	:	02/17/2026
Last Update Date	:	02/17/2026

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