Healthcare Provider Details

I. General information

NPI: 1023259405
Provider Name (Legal Business Name): KRISTA PUENTE TREFZ PSY,D,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2009
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E SHERIDAN RD
MELBOURNE FL
32901-3122
US

IV. Provider business mailing address

1370 BEDFORD DRIVE, SUITE 106
MELBOURNE FL
32940
US

V. Phone/Fax

Practice location:
  • Phone: 321-242-3110
  • Fax: 321-242-7464
Mailing address:
  • Phone: 321-253-8887
  • Fax: 321-253-8878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY7988
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: