Provider Demographics
NPI:1972104115
Name:TRUJILLO, ELEONORA (CNP)
Entity type:Individual
Prefix:
First Name:ELEONORA
Middle Name:
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 CALLE VIGIL
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-3655
Mailing Address - Country:US
Mailing Address - Phone:866-628-7828
Mailing Address - Fax:970-639-4475
Practice Address - Street 1:60 BALSA RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-8736
Practice Address - Country:US
Practice Address - Phone:505-412-3246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM61764363LA2100X, 363LP0808X
COC-APN.0102431-CNP363LA2100X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care