Healthcare Provider Details

I. General information

NPI: 1588576003
Provider Name (Legal Business Name): SAMANTHA TREVINO
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2742 CARICIA DR
HACIENDA HEIGHTS CA
91745-5242
US

IV. Provider business mailing address

2742 CARICIA DR
HACIENDA HEIGHTS CA
91745-5242
US

V. Phone/Fax

Practice location:
  • Phone: 626-482-1565
  • Fax:
Mailing address:
  • Phone: 626-482-1565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: