Healthcare Provider Details

I. General information

NPI: 1962087700
Provider Name (Legal Business Name): ALEJANDRO TREJO ESCALANTE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2021
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 N ANAHEIM BLVD
ANAHEIM CA
92805-2651
US

IV. Provider business mailing address

714 N ANAHEIM BLVD
ANAHEIM CA
92805-2651
US

V. Phone/Fax

Practice location:
  • Phone: 714-776-7490
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number11642
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: