Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 18136 | CA |
Y | 363L00000X | Nurse Practitioner | NP95009664 | CA |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 95009664 | CA |
NPI | 1003104423 |
---|---|
Provider Name | Dale Michael Trujillo |
First Address | San Diego, CA 92193-2410 |
Second Address | San Diego, CA 92103-9000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2011 |
Last Update Date | 18/03/2021 |