Healthcare Provider Details

I. General information

NPI: 1093209082
Provider Name (Legal Business Name): JAYME ERIKA TREVINO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5126 W DAYBREAK PKWY
SOUTH JORDAN UT
84009-5994
US

IV. Provider business mailing address

30 N MARIO CAPECCHI DR LEVEL 5 SOUTH
SALT LAKE CITY UT
84112
US

V. Phone/Fax

Practice location:
  • Phone: 801-213-2995
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2022010565
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207VC0300X
TaxonomyComplex Family Planning Physician
License Number14223979-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: