Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0700X | Adult Development & Aging Psychologist | 20131063992 | NV |
NPI | 1801211891 |
---|---|
Provider Name | Andrea Trujillo I |
First Address | Las Vegas, NV 89101-3702 |
Second Address | Las Vegas, NV 89101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2014 |
Last Update Date | 27/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
46-1989499 | (05) | NV |