Healthcare Provider Details

I. General information

NPI: 1639482110
Provider Name (Legal Business Name): SASHA BRIGETT TREJOS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10281 KIDD ST
RIVERSIDE CA
92503-3469
US

IV. Provider business mailing address

9990 COUNTY FARM RD STE 5
RIVERSIDE CA
92503-3542
US

V. Phone/Fax

Practice location:
  • Phone: 951-715-5050
  • Fax: 951-784-4986
Mailing address:
  • Phone: 951-715-5050
  • Fax: 951-784-4986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number76424
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: