Healthcare Provider Details

I. General information

NPI: 1346349354
Provider Name (Legal Business Name): HECTOR RAUL TREVINO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: HECTOR RAUL TREVINO M.D.

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2176 E GARRISON ST STE. C
EAGLE PASS TX
78852-5071
US

IV. Provider business mailing address

2176 E GARRISON ST STE. C
EAGLE PASS TX
78852-5071
US

V. Phone/Fax

Practice location:
  • Phone: 830-773-3353
  • Fax: 830-773-3393
Mailing address:
  • Phone: 830-773-3353
  • Fax: 830-773-3393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL0660
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: