Provider Demographics
NPI:1366612392
Name:TRUJILLO, HEATHER (LAC)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 KATHARINA PLACE
Mailing Address - Street 2:
Mailing Address - City:TWP. OF WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07676
Mailing Address - Country:US
Mailing Address - Phone:917-696-9925
Mailing Address - Fax:
Practice Address - Street 1:370 LEXINGTON AVE
Practice Address - Street 2:612
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6503
Practice Address - Country:US
Practice Address - Phone:917-696-9925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25003581171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist