Healthcare Provider Details

I. General information

NPI: 1528988326
Provider Name (Legal Business Name): CHRISTOPHER TREVINO
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25634 ALESSANDRO BLVD
MORENO VALLEY CA
92553-4916
US

IV. Provider business mailing address

15884 MARIPOSA DR
FONTANA CA
92336-5012
US

V. Phone/Fax

Practice location:
  • Phone: 951-571-4300
  • Fax:
Mailing address:
  • Phone: 909-519-8686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number36408
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: