Healthcare Provider Details

I. General information

NPI: 1538204623
Provider Name (Legal Business Name): JEFFREY WAYNE TREJO M.S., CCC-A,F-AAA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W SPEEDWAY BLVD
TUCSON AZ
85745-2326
US

IV. Provider business mailing address

1397 S LEE ST
SAINT DAVID AZ
85630-6217
US

V. Phone/Fax

Practice location:
  • Phone: 520-770-3689
  • Fax: 520-770-3782
Mailing address:
  • Phone: 520-720-4002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberDA1862
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: