Provider Demographics
NPI:1659109569
Name:TRUDEAU, MAKAYLA M (BS)
Entity type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:M
Last Name:TRUDEAU
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32865 TRAILWOOD CT
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-8275
Mailing Address - Country:US
Mailing Address - Phone:951-609-6983
Mailing Address - Fax:
Practice Address - Street 1:32865 TRAILWOOD CT
Practice Address - Street 2:
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-8275
Practice Address - Country:US
Practice Address - Phone:951-609-6983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer