Basic Information
| Provider Information | |||||||||
| NPI: | 1508817271 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRUJILLO | ||||||||
| FirstName: | LLOYD | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 136 N 3RD ST | ||||||||
| Address2: | |||||||||
| City: | LOMPOC | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934367002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056811761 | ||||||||
| FaxNumber: | 8056811768 | ||||||||
| Practice Location | |||||||||
| Address1: | 1017 E OCEAN AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | LOMPOC | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934367000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056811761 | ||||||||
| FaxNumber: | 8056811768 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 05/30/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 31687 | CO | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 01316876 | 05 | CO | MEDICAID |