Healthcare Provider Details

I. General information

NPI: 1538082755
Provider Name (Legal Business Name): ADRIEL TREJO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 JOANN ST
COSTA MESA CA
92626-6455
US

IV. Provider business mailing address

400 N TUSTIN AVE STE 120
SANTA ANA CA
92705-3879
US

V. Phone/Fax

Practice location:
  • Phone: 949-631-9045
  • Fax:
Mailing address:
  • Phone: 714-844-9612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: