Healthcare Provider Details

I. General information

NPI: 1952839292
Provider Name (Legal Business Name): ROXANNE TREVINO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROXANNE DEHAY

II. Dates (important events)

Enumeration Date: 05/31/2017
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 E FOOTHILL BLVD
RIALTO CA
92376-5230
US

IV. Provider business mailing address

1950 S SUNWEST LN STE 200
SAN BERNARDINO CA
92408-3248
US

V. Phone/Fax

Practice location:
  • Phone: 909-421-9206
  • Fax: 909-421-4677
Mailing address:
  • Phone: 909-252-4010
  • Fax: 909-252-4055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: