Provider Demographics
NPI:1184465155
Name:TREJO, STACEY LEIGH
Entity type:Individual
Prefix:MS
First Name:STACEY
Middle Name:LEIGH
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 1:10801 LEMON AVE APT 2425
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-3843
Mailing Address - Country:US
Mailing Address - Phone:760-889-0651
Mailing Address - Fax:
Practice Address - Street 1:2890 INLAND EMPIRE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-4649
Practice Address - Country:US
Practice Address - Phone:909-233-7265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker