Provider Demographics
NPI:1063712370
Name:TREJO, OLYMPIA
Entity type:Individual
Prefix:
First Name:OLYMPIA
Middle Name:
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 1:1725 WESTHAVEN CT
Mailing Address - Street 2:APT. I
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-1873
Mailing Address - Country:US
Mailing Address - Phone:831-763-4700
Mailing Address - Fax:
Practice Address - Street 1:225 WESTRIDGE DR
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-4168
Practice Address - Country:US
Practice Address - Phone:831-763-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70042FOtherCOUNTY OF SANTA CRUZ MEDI-CAL PROVIDER
CAFHC70044FOtherCOUNTY OF SANTA CRUZ MEDI-CAL PROVIDER
CAZZZ91892ZOtherCOUNTY OF SANTA CRUZ MEDICARE GROUP