Provider Demographics
NPI:1417206996
Name:TEMPLE-TRUJILLO, JESSE A (RN)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:A
Last Name:TEMPLE-TRUJILLO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7290 SAMUEL DRIVE
Mailing Address - Street 2:#300
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80221-2790
Mailing Address - Country:US
Mailing Address - Phone:303-269-2971
Mailing Address - Fax:303-269-2970
Practice Address - Street 1:7290 SAMUEL DRIVE
Practice Address - Street 2:#300
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80221-2790
Practice Address - Country:US
Practice Address - Phone:303-269-2971
Practice Address - Fax:303-269-2970
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO199185163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse