Provider Demographics
NPI:1902970080
Name:TRUJILLO, ALEXCIA Z (DOM)
Entity Type:Individual
Prefix:MS
First Name:ALEXCIA
Middle Name:Z
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:CAROL
Other - Last Name:GRIMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DOM
Mailing Address - Street 1:713 FLORIDA SE
Mailing Address - Street 2:ALEXCIA TRUJILLO DOM
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108
Mailing Address - Country:US
Mailing Address - Phone:505-265-6206
Mailing Address - Fax:505-265-5777
Practice Address - Street 1:135 MADISON NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108
Practice Address - Country:US
Practice Address - Phone:505-265-6206
Practice Address - Fax:505-265-5777
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM152171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist