Provider Demographics
NPI:1053407593
Name:TRUJILLO, JENNIFER C (DO)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:C
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:488 EAST VALLEY PARKWAY
Mailing Address - Street 2:310
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025
Mailing Address - Country:US
Mailing Address - Phone:760-233-1896
Mailing Address - Fax:760-294-7784
Practice Address - Street 1:488 E VALLEY PKWY
Practice Address - Street 2:310
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3363
Practice Address - Country:US
Practice Address - Phone:760-233-1896
Practice Address - Fax:760-294-7784
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8204174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX82040Medicaid
CA00AX82040Medicaid