Provider Demographics
NPI:1053194316
Name:TRUJILLO RODRIGUEZ, EIDY
Entity type:Individual
Prefix:
First Name:EIDY
Middle Name:
Last Name:TRUJILLO RODRIGUEZ
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 1:14760 GRANT LN
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-2724
Mailing Address - Country:US
Mailing Address - Phone:786-362-3655
Mailing Address - Fax:
Practice Address - Street 1:7875 NW 12TH ST STE 118
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33126-1815
Practice Address - Country:US
Practice Address - Phone:786-505-4449
Practice Address - Fax:786-667-3733
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician