Healthcare Provider Details

I. General information

NPI: 1417287541
Provider Name (Legal Business Name): PAUL TREVINO O.P.A.-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2010
Last Update Date: 07/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 BUDDY OWENS AVE
MCALLEN TX
78504-5427
US

IV. Provider business mailing address

PO BOX 6208
MCALLEN TX
78502-6208
US

V. Phone/Fax

Practice location:
  • Phone: 956-682-8998
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number1097
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1097
License Number State
# 3
Primary TaxonomyN
Taxonomy Code246ZX2200X
TaxonomyOrthopedic Assistant
License Number1097
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: