Healthcare Provider Details

I. General information

NPI: 1932458726
Provider Name (Legal Business Name): VIVIANA TREJO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2012
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6203 SAN IGNACIO AVE STE 150
SAN JOSE CA
95119-1371
US

IV. Provider business mailing address

6203 SAN IGNACIO AVE STE 150
SAN JOSE CA
95119-1371
US

V. Phone/Fax

Practice location:
  • Phone: 408-284-9080
  • Fax:
Mailing address:
  • Phone: 408-284-9080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT114745
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT148327
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: