Provider Demographics
NPI:1477386803
Name:TRUJILLO, MELYSSA CHRISTINE
Entity type:Individual
Prefix:
First Name:MELYSSA
Middle Name:CHRISTINE
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2153 W AVENUE K8
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-4622
Mailing Address - Country:US
Mailing Address - Phone:661-607-9752
Mailing Address - Fax:
Practice Address - Street 1:2153 W AVENUE K8
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-4622
Practice Address - Country:US
Practice Address - Phone:661-607-9752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician