Provider Demographics
NPI:1003448366
Name:TREGLE, JAYLEN DEANDRE
Entity Type:Individual
Prefix:
First Name:JAYLEN
Middle Name:DEANDRE
Last Name:TREGLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 CLEARPOINTE DR
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-8285
Mailing Address - Country:US
Mailing Address - Phone:707-980-4644
Mailing Address - Fax:
Practice Address - Street 1:216 CLEARPOINTE DR
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-8285
Practice Address - Country:US
Practice Address - Phone:707-980-4644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician