Healthcare Provider Details

I. General information

NPI: 1538321088
Provider Name (Legal Business Name): BETH A. TREVINO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 11/08/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 LAFAYETTE ST. GCHC WEST CLINIC
LAREDO TX
78041
US

IV. Provider business mailing address

1702 LAFAYETTE ST. GCHC WEST CLINIC
LAREDO TX
78041
US

V. Phone/Fax

Practice location:
  • Phone: 956-795-8100
  • Fax:
Mailing address:
  • Phone: 956-795-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberA99175
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number47066
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberP8090
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: