Provider Demographics
NPI:1174883813
Name:TREJO THERAPY INC
Entity type:Organization
Organization Name:TREJO THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:TREJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-228-1622
Mailing Address - Street 1:175 FONTAINEBLEAU BLVD
Mailing Address - Street 2:SUITE 1-G2
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-7018
Mailing Address - Country:US
Mailing Address - Phone:305-228-1622
Mailing Address - Fax:305-228-1611
Practice Address - Street 1:175 FONTAINEBLEAU BLVD
Practice Address - Street 2:SUITE 1-G2
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-7018
Practice Address - Country:US
Practice Address - Phone:305-228-1622
Practice Address - Fax:305-228-1611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-28
Last Update Date:2012-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC9440261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFILE 10005OtherAHCA HCC UNIT