Healthcare Provider Details

I. General information

NPI: 1447495122
Provider Name (Legal Business Name): ADVACE CARDIOLOGY GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2008
Last Update Date: 12/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 N VETERANS BLVD SUITE 8
EAGLE PASS TX
78852-4456
US

IV. Provider business mailing address

1975 N VETERANS BLVD SUITE 8
EAGLE PASS TX
78852-4456
US

V. Phone/Fax

Practice location:
  • Phone: 830-776-5818
  • Fax: 830-776-5814
Mailing address:
  • Phone: 830-776-5818
  • Fax: 830-776-5814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HECTOR R. TREVINO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 830-773-3353