MEDICARE: PABLO TREVINO DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	016.005288	IL
2	213ES0103X	Foot & Ankle Surgery Podiatrist	1856	TX

General Provider Information

NPI Number	:	1407041809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PABLO TREVINO DPM

Provider Business Mailing Address
First Line	:	6419 POLARIS
Second Line	:	SUITE A 1
City	:	LAREDO
State	:	TX
Zip	:	78041-4725
Country	:	US
Telephone Number	:	956-718-0075
Fax Number	:	956-718-0086

Provider Business Practice Location Address
First Line	:	6419 POLARIS
Second Line	:	SUITE A 1
City	:	LAREDO
State	:	TX
Zip	:	78041-4725
Country	:	US
Telephone Number	:	956-718-0075
Fax Number	:	956-718-0086

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2007
Last Update Date	:	09/15/2015

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