Provider Demographics
NPI:1871109645
Name:TRUJILLO, ZACHARRI WILLIAM (CAREGIVER,QMAP)
Entity type:Individual
Prefix:MR
First Name:ZACHARRI
Middle Name:WILLIAM
Last Name:TRUJILLO
Suffix:
Gender:M
Credentials:CAREGIVER,QMAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 55
Mailing Address - Street 2:
Mailing Address - City:COLLBRAN
Mailing Address - State:CO
Mailing Address - Zip Code:81624-0055
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1004 HIGH ST
Practice Address - Street 2:
Practice Address - City:COLLBRAN
Practice Address - State:CO
Practice Address - Zip Code:81624-5000
Practice Address - Country:US
Practice Address - Phone:970-312-6707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty