Provider Demographics
NPI:1407653983
Name:TRUJILLO GASTELUM, KRISVEL JANNETH
Entity type:Individual
Prefix:
First Name:KRISVEL
Middle Name:JANNETH
Last Name:TRUJILLO GASTELUM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 G ST APT C
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-3980
Mailing Address - Country:US
Mailing Address - Phone:619-451-2723
Mailing Address - Fax:
Practice Address - Street 1:223 G ST APT C
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-3980
Practice Address - Country:US
Practice Address - Phone:619-451-2723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA088751343900000X, 347C00000X, 343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle