Healthcare Provider Details

I. General information

NPI: 1295044642
Provider Name (Legal Business Name): ROBERTO TREVINO SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 10/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9910 HUEBNER RD STE 200
SAN ANTONIO TX
78240-1342
US

IV. Provider business mailing address

9910 HUEBNER RD STE 200
SAN ANTONIO TX
78240-1342
US

V. Phone/Fax

Practice location:
  • Phone: 210-691-0039
  • Fax: 210-699-0136
Mailing address:
  • Phone: 210-691-0039
  • Fax: 210-699-0136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number105950
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: