Provider Demographics
NPI:1154599009
Name:TRUJILLO, SARITA (RN)
Entity type:Individual
Prefix:
First Name:SARITA
Middle Name:
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1011
Mailing Address - Street 2:
Mailing Address - City:CHIMAYO
Mailing Address - State:NM
Mailing Address - Zip Code:87522-1011
Mailing Address - Country:US
Mailing Address - Phone:505-901-9516
Mailing Address - Fax:
Practice Address - Street 1:208 GUACHPANGUE RD
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-3424
Practice Address - Country:US
Practice Address - Phone:505-747-8187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NML20045164X00000X
NMRN67107163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse