Healthcare Provider Details

I. General information

NPI: 1376752576
Provider Name (Legal Business Name): RICARDO S TREVINO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 N MEADOW AVE
LAREDO TX
78040-5350
US

IV. Provider business mailing address

1212 N MEADOW AVE
LAREDO TX
78040-5350
US

V. Phone/Fax

Practice location:
  • Phone: 956-753-6493
  • Fax: 956-712-0016
Mailing address:
  • Phone: 956-753-6493
  • Fax: 956-712-0016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number116310
License Number StateTX

VIII. Authorized Official

Name: MR. RICARDO S TREVINO
Title or Position: OWNER
Credential:
Phone: 956-753-6493