Healthcare Provider Details

I. General information

NPI: 1912597378
Provider Name (Legal Business Name): DESIREE RENE TREJO RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2021
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1798 N GAREY AVE
POMONA CA
91767-2918
US

IV. Provider business mailing address

31558 GOLDEN LION DR
TEMECULA CA
92591-6941
US

V. Phone/Fax

Practice location:
  • Phone: 909-865-9500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number140769
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: