Healthcare Provider Details

I. General information

NPI: 1326311192
Provider Name (Legal Business Name): LUCINA B TREVINO M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2012
Last Update Date: 02/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 PLEASANTON RD SUITE 101
SAN ANTONIO TX
78214-1335
US

IV. Provider business mailing address

507 PLEASANTON RD SUITE 101
SAN ANTONIO TX
78214-1335
US

V. Phone/Fax

Practice location:
  • Phone: 210-433-3334
  • Fax: 210-932-2570
Mailing address:
  • Phone: 210-433-3334
  • Fax: 210-932-2570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberJ8805
License Number StateTX

VIII. Authorized Official

Name: LUCINA B TREVINO
Title or Position: OWNER
Credential: M.D.
Phone: 210-433-3334