Provider Demographics
NPI:1245227834
Name:TREJO, DAVID E (PA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:E
Last Name:TREJO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7230 GATEWAY BLVD E
Mailing Address - Street 2:SUITE E
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79915-1352
Mailing Address - Country:US
Mailing Address - Phone:915-599-1119
Mailing Address - Fax:915-592-9334
Practice Address - Street 1:7230 GATEWAY BLVD E
Practice Address - Street 2:SUITE E
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915-1352
Practice Address - Country:US
Practice Address - Phone:915-599-1119
Practice Address - Fax:915-592-9334
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PA01206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
8C0032Medicare ID - Type Unspecified
Q19465Medicare UPIN