Healthcare Provider Details

I. General information

NPI: 1528474897
Provider Name (Legal Business Name): KEVIN TRETO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 WILLOW CREEK RD STE 1200
PRESCOTT AZ
86301-1614
US

IV. Provider business mailing address

80 W MICHIGAN ST
ORLANDO FL
32806-4453
US

V. Phone/Fax

Practice location:
  • Phone: 928-458-2850
  • Fax: 928-458-2848
Mailing address:
  • Phone: 321-841-5142
  • Fax: 407-648-3686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number82530
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME142118
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: