Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | 57008 | CA |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 57008 | CA |
NPI | 1144392374 |
---|---|
Provider Name | German Trujillo |
First Address | San Diego, CA 92121-3020 |
Second Address | San Diego, CA 92121-3020 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 28/08/2019 |