Healthcare Provider Details

I. General information

NPI: 1750996484
Provider Name (Legal Business Name): ALLYOSSANA TREJO BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5954 SW 62ND ST
SOUTH MIAMI FL
33143-2250
US

IV. Provider business mailing address

5954 SW 62ND ST
SOUTH MIAMI FL
33143-2250
US

V. Phone/Fax

Practice location:
  • Phone: 786-717-3512
  • Fax:
Mailing address:
  • Phone: 786-717-3512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN9345501
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9345501
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: