Provider Demographics
NPI:1235261850
Name:TREVINO, DIANA MARIA (MA)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:MARIA
Last Name:TREVINO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:DIANA
Other - Middle Name:MARIA
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:PO BOX 716
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92033-0716
Mailing Address - Country:US
Mailing Address - Phone:760-855-6361
Mailing Address - Fax:760-436-9862
Practice Address - Street 1:200 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-5424
Practice Address - Country:US
Practice Address - Phone:760-726-4900
Practice Address - Fax:760-726-6102
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50201106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1009OtherMEDI-CAL STAFF ID NUMBER