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NPI Code Detail

MEDICARE: MR. JOSHUA TRUJILLO

MEDICARE: MR. JOSHUA 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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1578828729
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOSHUA TRUJILLO
Provider Business Mailing Address
First Line : 293 JAMIE LN
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10312-6641
Country : US
Telephone Number : 718-816-3481
Fax Number :
Provider Business Practice Location Address
First Line : 400 LAKE AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10303-2629
Country : US
Telephone Number : 718-816-3481
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2012
Last Update Date : 07/12/2012

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Directions to “ MR. JOSHUA TRUJILLO ” Practice Location

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