Provider Demographics
NPI:1497328363
Name:TREJO, JOSE OMAR
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:OMAR
Last Name:TREJO
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 1:3017 N. MARTIN L. KING AVE.
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73111
Mailing Address - Country:US
Mailing Address - Phone:405-427-3200
Mailing Address - Fax:
Practice Address - Street 1:3017 N. MARTIN L. KING AVENUE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73111-7311
Practice Address - Country:US
Practice Address - Phone:405-427-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator