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General NPI Number Information
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NPI Number | 1750736849
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Entity Type | Individual
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Provider Name | TREVINE ROSHAN ALBERT D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/26/2016
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Last Update Date | 06/17/2020
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Provider Practice Location Address
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Address Line | 7031 SW 62ND AVE
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-4701
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Country | US
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Telephone | 305-284-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 4109 N FEDERAL HWY
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-5530
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Country | US
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Telephone | 305-284-7775
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Fax |
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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 | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | OS14935
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License Number State | FL
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