Active NPI
David Michael Trejo, BCBA-D,PHD
- Psychologist
- San Diego, CA
National Provider Identifier
1467775486
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY27102
- Practice address
- 5080 Shoreham Place
Suite 103
San Diego, CA 92122 - Phone
- (858) 272-2662
- Fax
- (858) 272-2661
- NPI assigned
- Mar 4, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY27102 | CA | Primary |
| Behavior Analyst | 103K00000X | 01-06-2707 |
Addresses
Primary practice location
5080 Shoreham Place
Suite 103
San Diego, CA 92122
Mailing address
5080 Shoreham Place
Suite 103
San Diego, CA 92122
Phone (858) 272-2662
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY27102 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1267660800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1428969600000",
"number": "1467775486",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5080 SHOREHAM PLACE",
"address_2": "SUITE 103",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "92122",
"telephone_number": "858-272-2662",
"fax_number": "858-272-2661"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5080 SHOREHAM PLACE",
"address_2": "SUITE 103",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "92122",
"telephone_number": "858-272-2662",
"fax_number": "858-272-2661"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TREJO",
"first_name": "DAVID",
"middle_name": "MICHAEL",
"name_prefix": "Mr.",
"credential": "BCBA-D,PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-03-04",
"last_updated": "2015-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY27102",
"primary": true
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": "01-06-2707",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.