Healthcare Provider Details

I. General information

NPI: 1679766281
Provider Name (Legal Business Name): JOSE E. TREJO MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 EL CAMINO REAL
SOUTH SAN FRANCISCO CA
94080-3208
US

IV. Provider business mailing address

4 BRUCE AVE
SAN FRANCISCO CA
94112-2322
US

V. Phone/Fax

Practice location:
  • Phone: 650-742-2151
  • Fax: 650-742-2591
Mailing address:
  • Phone: 415-239-8272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22099
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: