1528051489 NPI number — ESTHER TREVINO MTF

Table of content: ESTHER TREVINO MTF (NPI 1528051489)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528051489 NPI number — ESTHER TREVINO MTF

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TREVINO
Provider First Name:
ESTHER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MTF
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TREVINO-DE LA CHAUMIERE
Provider Other First Name:
ESTHER
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MFT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1528051489
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1612 S DORA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UKIAH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95482-6519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-468-9030
Provider Business Mailing Address Fax Number:
707-468-4313

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19343 HIGHWAY 12
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SONOMA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95476-5445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-896-4585
Provider Business Practice Location Address Fax Number:
707-468-4313
Provider Enumeration Date:
08/25/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC18107 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MFT181070 . This is a "BLUE SHIELD OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: MFC18107 . This is a "BLUE CROSS OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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