Provider Demographics
NPI:1215268495
Name:TRUJILLO, JESUS A (RD)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:A
Last Name:TRUJILLO
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3552 PACIFICA LN
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-4642
Mailing Address - Country:US
Mailing Address - Phone:916-682-7385
Mailing Address - Fax:
Practice Address - Street 1:2218 KAUSEN DR
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-7115
Practice Address - Country:US
Practice Address - Phone:916-683-8774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA965542133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered