1750484366 NPI number — MRS. TRILLA RODESILLAS CAJULIS DDS

Table of content: MRS. TRILLA RODESILLAS CAJULIS DDS (NPI 1750484366)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750484366 NPI number — MRS. TRILLA RODESILLAS CAJULIS DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAJULIS
Provider First Name:
TRILLA
Provider Middle Name:
RODESILLAS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

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:
1750484366
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2488 CROOKED TRAIL ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHULA VISTA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-271-2570
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
890 EAST LAKE PARKWAY
Provider Second Line Business Practice Location Address:
STE 206
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-946-7477
Provider Business Practice Location Address Fax Number:
619-397-0314
Provider Enumeration Date:
09/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  45358 , 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)





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