Basic Information
| Provider Information | |||||||||
| NPI: | 1932411022 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRUJILLO | ||||||||
| FirstName: | AIMEE | ||||||||
| MiddleName: | KATHARINE BELIER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23082 RIDGE ROUTE DR STE A | ||||||||
| Address2: | |||||||||
| City: | LAKE FOREST | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926303691 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495653572 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 23082 RIDGE ROUTE DR STE A | ||||||||
| Address2: | |||||||||
| City: | LAKE FOREST | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926303691 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9498372766 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2010 | ||||||||
| LastUpdateDate: | 01/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0400X | 60965 | CA | N | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics | 1223G0001X | 60965 | CA | Y | Dental Providers | Dentist | General Practice |
No ID Information.