Provider Demographics
NPI:1669027256
Name:TREJO, YVETTE GRACE
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:GRACE
Last Name:TREJO
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 1:474 S CITRUS AVE
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-4733
Mailing Address - Country:US
Mailing Address - Phone:626-858-9500
Mailing Address - Fax:713-643-2967
Practice Address - Street 1:474 S CITRUS AVE
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-4733
Practice Address - Country:US
Practice Address - Phone:626-858-9500
Practice Address - Fax:713-643-2967
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)