Provider Demographics
NPI:1861482671
Name:NEUFELD-TRUJILLO, JENNIFER LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:NEUFELD-TRUJILLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:TRUJILLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:193 FAIRVIEW LN STE L
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-4828
Mailing Address - Country:US
Mailing Address - Phone:209-536-5120
Mailing Address - Fax:
Practice Address - Street 1:193 SOUTH FAIRVIEW LANE
Practice Address - Street 2:STE L
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370
Practice Address - Country:US
Practice Address - Phone:209-536-5120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78572208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H92798Medicare UPIN