Provider Demographics
NPI:1760039218
Name:REDITO, TRISHA MAE PAREDES
Entity Type:Individual
Prefix:
First Name:TRISHA MAE
Middle Name:PAREDES
Last Name:REDITO
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 1:2580 SAINT CLOUD DR
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-1741
Mailing Address - Country:US
Mailing Address - Phone:650-580-9453
Mailing Address - Fax:
Practice Address - Street 1:795 WILLOW RD BLDG 332
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-2539
Practice Address - Country:US
Practice Address - Phone:650-324-1470
Practice Address - Fax:650-324-4149
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)