MEDICARE: MR. ALEX 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	101YA0400X	Addiction (Substance Use Disorder) Counselor	7297	CA

General Provider Information

NPI Number	:	1770203697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALEX TRUJILLO

Provider Business Mailing Address
First Line	:	2101 E 1ST ST
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-4007
Country	:	US
Telephone Number	:	714-542-3581
Fax Number	:

Provider Business Practice Location Address
First Line	:	5304 ORANGE AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-6018
Country	:	US
Telephone Number	:	714-717-2502
Fax Number	:

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

Provider Enumeration Date	:	08/31/2022
Last Update Date	:	08/31/2022

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Directions to “ MR. ALEX TRUJILLO ” Practice Location

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