Healthcare Provider Details

I. General information

NPI: 1720776487
Provider Name (Legal Business Name): ARTURO MARTINEZ TREVINO JR. FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2023
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S WILLIAM ST
SOUTH BEND IN
46601-2515
US

IV. Provider business mailing address

201 S WILLIAM ST
SOUTH BEND IN
46601-2515
US

V. Phone/Fax

Practice location:
  • Phone: 574-234-2870
  • Fax: 574-232-2872
Mailing address:
  • Phone: 574-234-2870
  • Fax: 574-232-2872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71018496A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11026181
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9396221
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28305897A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: