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General NPI Number Information
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NPI Number | 1245281930
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Entity Type | Organization
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Legal Business Name | MICHELLE J TREVINO
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 2207 N RAUL LONGORIA RD
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City | SAN JUAN
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State | TX
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Zip | 78589-4114
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Country | US
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Telephone | 956-783-8875
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Fax | 956-783-3072
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Provider Business Mailing Address
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Address Line | 2207 RAUL LONGORIA ST
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City | SAN JUAN
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State | TX
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Zip | 78589-4114
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Country | US
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Telephone | 956-783-8875
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Fax | 956-783-3072
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. JOE ALVAREZ
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Credential |
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Telephone | 956-783-8875
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 0012763
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License Number State | TX
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