Provider Demographics
NPI:1194786855
Name:TRUJILLO, MARK C (CST/CFA)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:C
Last Name:TRUJILLO
Suffix:
Gender:M
Credentials:CST/CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SANDPIPER CIR
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-4103
Mailing Address - Country:US
Mailing Address - Phone:303-659-0606
Mailing Address - Fax:
Practice Address - Street 1:788 S 10TH AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-3237
Practice Address - Country:US
Practice Address - Phone:303-659-0606
Practice Address - Fax:303-480-1109
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCERTIFICATION F01493246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist