Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | A016110315 | CA |
NPI | 1003370073 |
---|---|
Provider Name | Michael Andrew Trujillo |
First Address | La Crescenta, CA 91214-3349 |
Second Address | Lake View Terrace, CA 91342-6506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2019 |
Last Update Date | 24/01/2019 |