Healthcare Provider Details

I. General information

NPI: 1386650745
Provider Name (Legal Business Name): CHRIS T TREVINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CHRISTOPHER T TREVINO MD

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41229 HIGHWAY 941
GONZALES LA
70737-8206
US

IV. Provider business mailing address

41229 HIGHWAY 941
GONZALES LA
70737-8206
US

V. Phone/Fax

Practice location:
  • Phone: 225-806-3397
  • Fax: 225-644-1423
Mailing address:
  • Phone: 225-806-3397
  • Fax: 225-644-1423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number023255
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number023255
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: