Basic Information
| Provider Information | |||||||||
| NPI: | 1316275738 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRUJILLO | ||||||||
| FirstName: | GLORIA | ||||||||
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| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3520 BUSHWICK ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2138803393 | ||||||||
| FaxNumber: | 3233120642 | ||||||||
| Practice Location | |||||||||
| Address1: | 2677 ZOE AVE | ||||||||
| Address2: | #303A | ||||||||
| City: | HUNTINGTON PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3233120640 | ||||||||
| FaxNumber: | 3233120642 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2009 | ||||||||
| LastUpdateDate: | 11/23/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.