Provider Demographics
NPI:1609310283
Name:TRUJILLO, MARIA T (DH)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:T
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:DH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19969 GREENLEY RD STE D
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5908
Mailing Address - Country:US
Mailing Address - Phone:209-532-0034
Mailing Address - Fax:
Practice Address - Street 1:19969 GREENLEY RD STE D
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5908
Practice Address - Country:US
Practice Address - Phone:209-532-0034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-15
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28119124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist