Healthcare Provider Details

I. General information

NPI: 1487658225
Provider Name (Legal Business Name): VICKI MAREE TREVINO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VICKI MAREE GUZMAN PA

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date: 06/14/2006
Reactivation Date: 03/29/2007

III. Provider practice location address

4815 N ASSEMBLY ST
SPOKANE WA
99205-6185
US

IV. Provider business mailing address

4815 N ASSEMBLY ST
SPOKANE WA
99205-6185
US

V. Phone/Fax

Practice location:
  • Phone: 509-434-7000
  • Fax:
Mailing address:
  • Phone: 509-434-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA17774
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60790077
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: