Healthcare Provider Details

I. General information

NPI: 1346242393
Provider Name (Legal Business Name): DANIEL G TREVINO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2005
Last Update Date: 03/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 STONE OAK LOOP
SAN ANTONIO TX
78258-3391
US

IV. Provider business mailing address

13750 SAN PEDRO AVE SUITE 560
SAN ANTONIO TX
78232-4375
US

V. Phone/Fax

Practice location:
  • Phone: 210-495-7334
  • Fax: 210-495-7203
Mailing address:
  • Phone: 210-561-3100
  • Fax: 210-545-3076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberJ7700
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: