Provider Demographics
NPI:1306128681
Name:TREJO, SERGIO MAURICIO (MFTI)
Entity type:Individual
Prefix:
First Name:SERGIO
Middle Name:MAURICIO
Last Name:TREJO
Suffix:
Gender:M
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 SHASTA STREET
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063
Mailing Address - Country:US
Mailing Address - Phone:650-599-1038
Mailing Address - Fax:650-368-4001
Practice Address - Street 1:727 SHASTA ST
Practice Address - Street 2:SUITE 4900
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-2124
Practice Address - Country:US
Practice Address - Phone:650-599-1038
Practice Address - Fax:650-368-4001
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68657106H00000X
CALMFT97196106H00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health