Provider Demographics
NPI:1902602386
Name:TRUJILLO, TANIA (CBHCM)
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:TRUJILLO
Suffix:
Gender:
Credentials:CBHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18333 SW 138TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-6440
Mailing Address - Country:US
Mailing Address - Phone:786-879-3264
Mailing Address - Fax:850-616-0498
Practice Address - Street 1:18333 SW 138TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-6440
Practice Address - Country:US
Practice Address - Phone:786-879-3264
Practice Address - Fax:850-616-0498
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCM-0103482104100000X
FLCBHCM.0103482171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker