MEDICARE: CHLOE ELISA TREVINO C.S.A.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1275891160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHLOE ELISA TREVINO C.S.A.

Provider Business Mailing Address
First Line	:	2009 LONG DR
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-4923
Country	:	US
Telephone Number	:	832-367-8773
Fax Number	:

Provider Business Practice Location Address
First Line	:	2009 LONG DR
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-4923
Country	:	US
Telephone Number	:	832-367-8773
Fax Number	:

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

Provider Enumeration Date	:	04/27/2012
Last Update Date	:	04/27/2012

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