Provider Demographics
NPI:1669665816
Name:TREVINO, REBECCA DENISE
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:DENISE
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 1:630 JUNIPERO AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90814-3731
Mailing Address - Country:US
Mailing Address - Phone:562-987-5742
Mailing Address - Fax:562-438-6891
Practice Address - Street 1:630 JUNIPERO AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90814-3731
Practice Address - Country:US
Practice Address - Phone:562-987-5742
Practice Address - Fax:562-438-6891
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA190077AHNMedicaid