Provider Demographics
NPI:1346449444
Name:TREVINO, KATHRYN JANET
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:JANET
Last Name:TREVINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 MARCONI AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-3866
Mailing Address - Country:US
Mailing Address - Phone:916-485-4175
Mailing Address - Fax:916-485-2673
Practice Address - Street 1:3815 MARCONI AVE STE 1
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-3866
Practice Address - Country:US
Practice Address - Phone:916-485-4175
Practice Address - Fax:916-485-2673
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker