Provider Demographics
NPI:1023259405
Name:TREFZ, KRISTA PUENTE (PSY,D,)
Entity type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:PUENTE
Last Name:TREFZ
Suffix:
Gender:F
Credentials:PSY,D,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 BEDFORD DRIVE, SUITE 106
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940
Mailing Address - Country:US
Mailing Address - Phone:321-253-8887
Mailing Address - Fax:321-253-8878
Practice Address - Street 1:400 E SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3122
Practice Address - Country:US
Practice Address - Phone:321-242-3110
Practice Address - Fax:321-242-7464
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-16
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7988103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCQ027ZMedicare UPIN