Provider Demographics
NPI:1760128144
Name:TREVINO, LUIS DANIEL (CADC)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:DANIEL
Last Name:TREVINO
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 F ST
Mailing Address - Street 2:
Mailing Address - City:WASCO
Mailing Address - State:CA
Mailing Address - Zip Code:93280-2040
Mailing Address - Country:US
Mailing Address - Phone:661-674-3378
Mailing Address - Fax:661-759-5070
Practice Address - Street 1:928 F ST
Practice Address - Street 2:
Practice Address - City:WASCO
Practice Address - State:CA
Practice Address - Zip Code:93280-2040
Practice Address - Country:US
Practice Address - Phone:661-674-3378
Practice Address - Fax:661-759-5070
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACI35560422101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)