Provider Demographics
NPI:1255804944
Name:TREJO, JORGE (SA-C)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:TREJO
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 KATY GAP RD APT 1422
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-7892
Mailing Address - Country:US
Mailing Address - Phone:409-995-9169
Mailing Address - Fax:
Practice Address - Street 1:1002 KATY GAP RD APT 1422
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-7892
Practice Address - Country:US
Practice Address - Phone:409-995-9169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-06
Last Update Date:2019-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18-526246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant