Provider Demographics
NPI:1023777364
Name:TRUJILLO CONSULTING
Entity type:Organization
Organization Name:TRUJILLO CONSULTING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUJILLO
Authorized Official - Suffix:
Authorized Official - Credentials:WHNP
Authorized Official - Phone:907-406-4025
Mailing Address - Street 1:PO BOX 771843
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-1843
Mailing Address - Country:US
Mailing Address - Phone:907-223-2180
Mailing Address - Fax:
Practice Address - Street 1:1200 AIRPORT HEIGHTS DR STE 240
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2970
Practice Address - Country:US
Practice Address - Phone:907-406-4025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-14
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1020629Medicaid
AK1725380Medicaid