Basic Information
Provider Information
NPI: 1730138967
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TRUJILLO
FirstName: ALFREDO
MiddleName: E
NamePrefix:  
NameSuffix:  
Credential: M.D
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 604 GAY RD
Address2:  
City: SEFFNER
State: FL
PostalCode: 335844168
CountryCode: US
TelephoneNumber: 8136439333
FaxNumber:  
Practice Location
Address1: 206 E BRANDON BLVD
Address2:  
City: BRANDON
State: FL
PostalCode: 335115221
CountryCode: US
TelephoneNumber: 8136815571
FaxNumber: 8136898128
Other Information
ProviderEnumerationDate: 05/06/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X33108FLY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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