Basic Information
| Provider Information | |||||||||
| NPI: | 1528509338 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRUJILLO | ||||||||
| FirstName: | JOMAIRA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3000 GOFFS FALLS RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031111000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009952673 | ||||||||
| FaxNumber: | 8889796551 | ||||||||
| Practice Location | |||||||||
| Address1: | 3000 GOFFS FALLS RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031111000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009952673 | ||||||||
| FaxNumber: | 8889796551 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2017 | ||||||||
| LastUpdateDate: | 03/13/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | PN5201902 | FL | N | Nursing Service Providers | Registered Nurse | 164W00000X | 77086 | NC | Y | Nursing Service Providers | Licensed Practical Nurse | 164W00000X | 26NP06648600 | NJ | N | Nursing Service Providers | Licensed Practical Nurse | 164W00000X | 686870 | CA | N | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.