Healthcare Provider Details

I. General information

NPI: 1740625243
Provider Name (Legal Business Name): AMERICA TREVINO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2013
Last Update Date: 05/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3424 KOSSUTH AVE
BRONX NY
10467-2410
US

IV. Provider business mailing address

3424 KOSSUTH AVE
BRONX NY
10467-2410
US

V. Phone/Fax

Practice location:
  • Phone: 718-519-3975
  • Fax:
Mailing address:
  • Phone: 718-519-3975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number445165
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: