Provider Demographics
NPI:1841967239
Name:TREJO, CHARLIE (PTA)
Entity type:Individual
Prefix:
First Name:CHARLIE
Middle Name:
Last Name:TREJO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4913 SUNBURST DR
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93552-5208
Mailing Address - Country:US
Mailing Address - Phone:661-526-9747
Mailing Address - Fax:
Practice Address - Street 1:22961 SOLEDAD CANYON RD
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350-2633
Practice Address - Country:US
Practice Address - Phone:661-200-3677
Practice Address - Fax:661-388-4496
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51360208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation