Provider Demographics
NPI:1962696864
Name:REBECCA S DAVIS-TRUJILLO MD PC
Entity type:Organization
Organization Name:REBECCA S DAVIS-TRUJILLO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:S
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-473-8595
Mailing Address - Street 1:1715 N WEBER ST
Mailing Address - Street 2:#270
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-7532
Mailing Address - Country:US
Mailing Address - Phone:719-473-8595
Mailing Address - Fax:719-473-8593
Practice Address - Street 1:1715 N WEBER ST
Practice Address - Street 2:#270
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-7532
Practice Address - Country:US
Practice Address - Phone:719-473-8595
Practice Address - Fax:719-473-8593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31545207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty