Provider Demographics
NPI:1083263362
Name:TREJO CARDOSO, JOSE CARLOS
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:CARLOS
Last Name:TREJO CARDOSO
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 1:3925 N MLK BLVD STE 212
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-7676
Mailing Address - Country:US
Mailing Address - Phone:702-461-1982
Mailing Address - Fax:
Practice Address - Street 1:3925 N MLK BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-7673
Practice Address - Country:US
Practice Address - Phone:702-461-1982
Practice Address - Fax:702-476-1191
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner