Provider Demographics
NPI:1821658923
Name:TREVINO, DESIREE RENEE (HIGH SCHOOL DIPLOMA)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:RENEE
Last Name:TREVINO
Suffix:
Gender:F
Credentials:HIGH SCHOOL DIPLOMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2432 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-1211
Mailing Address - Country:US
Mailing Address - Phone:559-269-3372
Mailing Address - Fax:
Practice Address - Street 1:1690 W SHAW AVE STE 102
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3518
Practice Address - Country:US
Practice Address - Phone:559-255-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician