Healthcare Provider Details

I. General information

NPI: 1093209082
Provider Name (Legal Business Name): JAYME ERIKA TREVINO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 FOREST PARK AVE DIV OBGYN FAMILY PLANNING, STE 710
SAINT LOUIS MO
63108-1495
US

IV. Provider business mailing address

PO BOX 60352
SAINT LOUIS MO
63160-0352
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-4211
  • Fax: 888-315-6494
Mailing address:
  • Phone: 314-362-4211
  • Fax: 888-315-6494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VC0300X
TaxonomyComplex Family Planning Physician
License Number14223979-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2022010565
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: