Provider Demographics
NPI:1588031777
Name:TREJO, LYDIA ANN (NP)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:ANN
Last Name:TREJO
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:45 NE LOOP 410
Mailing Address - Street 2:SUITE 850
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-5832
Mailing Address - Country:US
Mailing Address - Phone:210-805-9800
Mailing Address - Fax:210-805-8770
Practice Address - Street 1:423 TREELINE PARK
Practice Address - Street 2:SUITE 325
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-2060
Practice Address - Country:US
Practice Address - Phone:210-546-1460
Practice Address - Fax:210-805-8770
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2016-12-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXAP128588363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily