1982180832 NPI number — DENISE ROCHELLE TRUJILLO CCAPP R1310960618

Table of content: DENISE ROCHELLE TRUJILLO CCAPP R1310960618 (NPI 1982180832)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982180832 NPI number — DENISE ROCHELLE TRUJILLO CCAPP R1310960618

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRUJILLO
Provider First Name:
DENISE
Provider Middle Name:
ROCHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CCAPP R1310960618
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:
1982180832
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3218
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93385-3218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-869-1795
Provider Business Mailing Address Fax Number:
661-869-1794

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
708 LINCOLN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93305-3711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-869-1795
Provider Business Practice Location Address Fax Number:
661-869-1794
Provider Enumeration Date:
07/13/2018

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: 101YA0400X , with the licence number:  R1310960618 , 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: R1310960618 . This is a "CCAPP REGISTRATION" identifier . This identifiers is of the category "OTHER".




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