Provider Demographics
NPI:1609767524
Name:TREJO, LORENA MICHELLE
Entity type:Individual
Prefix:
First Name:LORENA
Middle Name:MICHELLE
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 1:5712 N NEW HAMPSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3135
Mailing Address - Country:US
Mailing Address - Phone:708-699-5257
Mailing Address - Fax:
Practice Address - Street 1:5930 CORNERSTONE CT W
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3741
Practice Address - Country:US
Practice Address - Phone:866-687-7390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704412808163W00000X
WI1112349-30163W00000X
NY967979163W00000X
CA95401275163W00000X
IL041.522123163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse