Healthcare Provider Details

I. General information

NPI: 1780278903
Provider Name (Legal Business Name): MARIBEL TREJO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2021
Last Update Date: 02/28/2021
Certification Date: 02/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 CHESTNUT AVE
LONG BEACH CA
90813-1674
US

IV. Provider business mailing address

807 W MCFADDEN AVE
SANTA ANA CA
92707-1111
US

V. Phone/Fax

Practice location:
  • Phone: 562-599-8444
  • Fax:
Mailing address:
  • Phone: 714-321-8556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95125411
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number95125411
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: