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General NPI Number Information
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NPI Number | 1639811748
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Entity Type | Individual
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Provider Name | ADRIAN ELISEO MAR TREVINO
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Gender | Male
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Dates
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Enumeration Date | 04/09/2022
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Last Update Date | 08/25/2022
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Provider Practice Location Address
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Address Line | 3193 W ALTON GLOOR BLVD STE M
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City | BROWNSVILLE
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State | TX
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Zip | 78520-3509
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Country | US
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Telephone | 956-801-2278
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Fax | 956-594-4219
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Provider Business Mailing Address
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Address Line | 3751 E 14TH ST SUITE 111
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City | BROWNSVILLE
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State | TX
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Zip | 78521
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Country | US
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Telephone | 956-801-2278
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Fax | 956-594-4219
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | 021230
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License Number State | TX
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