1154612570 NPI number — ISRAEL TRUJILLO MD

Table of content: (NPI 1154612570)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154612570 NPI number — ISRAEL TRUJILLO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ISRAEL TRUJILLO MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154612570
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27 W MICHELTORENA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA BARBARA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93101-2509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-963-1471
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27 W MICHELTORENA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA BARBARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93101-2509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-963-1471
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/20/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TORRES
Authorized Official First Name:
ISRAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
805-963-1471

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X , with the licence number:  A110806 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 41980 . This is a "ARIZONA MEDICAL BOARD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: A110806 . This is a "THE MEDICAL BOARD OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".