Healthcare Provider Details

I. General information

NPI: 1952664096
Provider Name (Legal Business Name): KIMBERLY TREJO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 06/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W BULLARD AVE SUITE 124
CLOVIS CA
93612-0861
US

IV. Provider business mailing address

255 W BULLARD AVE SUITE 124
CLOVIS CA
93612-0861
US

V. Phone/Fax

Practice location:
  • Phone: 559-297-1300
  • Fax: 559-324-7534
Mailing address:
  • Phone: 559-297-1300
  • Fax: 559-324-7534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number28328
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: