MEDICARE: CASEY 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	235Z00000X	Speech-Language Pathologist	SLP-2023-0273	NM

General Provider Information

NPI Number	:	1801757299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASEY TRUJILLO

Provider Business Mailing Address
First Line	:	PO BOX 143
Second Line	:
City	:	VADITO
State	:	NM
Zip	:	87579-0143
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	745 N RIVERSIDE DR STE F
Second Line	:
City	:	ESPANOLA
State	:	NM
Zip	:	87532-2889
Country	:	US
Telephone Number	:	505-660-5489
Fax Number	:

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

Provider Enumeration Date	:	11/24/2025
Last Update Date	:	11/24/2025

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Directions to “ CASEY TRUJILLO ” Practice Location

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