Provider Demographics
NPI:1558871947
Name:TRUJILLO, SERGIO HERNANDEZ (LVN)
Entity type:Individual
Prefix:
First Name:SERGIO
Middle Name:HERNANDEZ
Last Name:TRUJILLO
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12021 S WILMINGTON AVE
Mailing Address - Street 2:BUILDING 18 SUITE 101
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90059
Mailing Address - Country:US
Mailing Address - Phone:424-454-6001
Mailing Address - Fax:
Practice Address - Street 1:12021 S WILMINGTON AVE
Practice Address - Street 2:BUILDING 18 SUITE 101
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059
Practice Address - Country:US
Practice Address - Phone:424-454-6001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA181600164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse