Healthcare Provider Details

I. General information

NPI: 1285335257
Provider Name (Legal Business Name): FERNANDO RIOS TREVINO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 DALLAS PKWY
FRISCO TX
75034-9580
US

IV. Provider business mailing address

5700 DALLAS PKWY
FRISCO TX
75034-9580
US

V. Phone/Fax

Practice location:
  • Phone: 469-515-7222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number1374276
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: