Provider Demographics
NPI:1285806794
Name:TRUJILLO, MIGUEL (PA-C)
Entity type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:
Last Name:TRUJILLO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29361 CLEAR VIEW LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-5442
Mailing Address - Country:US
Mailing Address - Phone:909-425-9165
Mailing Address - Fax:
Practice Address - Street 1:685 CARNEGIE DR STE 230
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3583
Practice Address - Country:US
Practice Address - Phone:909-890-0407
Practice Address - Fax:909-890-0575
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15656363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant