MEDICARE: LARA TREVINO NP

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	163W00000X	Registered Nurse	691374-1	NY
2	363LA2200X	Adult Health Nurse Practitioner	F307592-1	NY

General Provider Information

NPI Number	:	1487046397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARA TREVINO NP

Provider Business Mailing Address
First Line	:	85 W BURNSIDE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10453-4015
Country	:	US
Telephone Number	:	718-716-4400
Fax Number	:

Provider Business Practice Location Address
First Line	:	304 W 88TH ST
Second Line	:	3D
City	:	NEW YORK
State	:	NY
Zip	:	10024-2227
Country	:	US
Telephone Number	:	214-864-4882
Fax Number	:

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

Provider Enumeration Date	:	03/02/2015
Last Update Date	:	03/28/2016

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Directions to “ LARA TREVINO NP” Practice Location

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