MEDICARE: ANDREA TRUJILLO I

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	103TA0700X	Adult Development & Aging Psychologist	20131063992	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801211891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA TRUJILLO I

Provider Business Mailing Address
First Line	:	3020 E BONANZA RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-3702
Country	:	US
Telephone Number	:	702-771-9128
Fax Number	:	702-982-3069

Provider Business Practice Location Address
First Line	:	3020 E BONANZA SUITE 160-A
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101
Country	:	US
Telephone Number	:	702-771-9128
Fax Number	:	702-982-3069

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

Provider Enumeration Date	:	02/27/2014
Last Update Date	:	02/27/2014

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