Healthcare Provider Details

I. General information

NPI: 1093193534
Provider Name (Legal Business Name): JUANITA TREVINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 PREMIER DRIVE SUITE #234
IRVING TX
75063
US

IV. Provider business mailing address

500 FAIRWAY DR STE 102
DEERFIELD BCH FL
33441-1817
US

V. Phone/Fax

Practice location:
  • Phone: 972-756-1222
  • Fax: 469-374-0800
Mailing address:
  • Phone: 888-880-9270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235500000X
TaxonomySpeech/Language/Hearing Specialist/Technologist
License NumberRBT-15-8217-21224
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: