MEDICARE: JAMIE TREVINO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103K00000X	Behavior Analyst
2	225400000X	Rehabilitation Practitioner
3	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1114221876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE TREVINO

Provider Business Mailing Address
First Line	:	4132 S RAINBOW BLVD # 172
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-3106
Country	:	US
Telephone Number	:	702-706-8062
Fax Number	:

Provider Business Practice Location Address
First Line	:	4132 S RAINBOW BLVD # 172
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-3106
Country	:	US
Telephone Number	:	702-706-8062
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2011
Last Update Date	:	12/12/2024

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Directions to “ JAMIE TREVINO ” Practice Location

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