Individual
KENNY JUNIOR RODRIGUEZ TRUJILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
250 BON AIR ROAD, UNIT B - 1ST FLOOR (ACCESS TEAM), GREENBRAE, CA 94904
(888) 818-1115
Mailing address
250 BON AIR ROAD, UNIT B - 1ST FLOOR (ACCESS TEAM), GREENBRAE, CA 94904
(888) 818-1115
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
MPSS-IJQGWM
CA
175T00000X
Peer Specialist
Primary
MPSS-IJQGWM
CA
225400000X
Rehabilitation Practitioner
MPSS-IJQGWM
CA
Other
Enumeration date
01/25/2021
Last updated
04/08/2024
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