Healthcare Provider Details

I. General information

NPI: 1275616310
Provider Name (Legal Business Name): RICHARD J. TREVINO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 N JACKSON AVE STE 235
SAN JOSE CA
95116-1635
US

IV. Provider business mailing address

227 N JACKSON AVE STE 235
SAN JOSE CA
95116-1635
US

V. Phone/Fax

Practice location:
  • Phone: 408-926-5300
  • Fax: 408-926-5395
Mailing address:
  • Phone: 408-926-5300
  • Fax: 408-926-5395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberC29426
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License NumberC29426
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: