MEDICARE: CARLOS TREVINO

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	183500000X	Pharmacist	RP00008647	NM

General Provider Information

NPI Number	:	1629513791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS TREVINO

Provider Business Mailing Address
First Line	:	1021 E PINE ST
Second Line	:
City	:	DEMING
State	:	NM
Zip	:	88030-7009
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1021 E PINE ST
Second Line	:
City	:	DEMING
State	:	NM
Zip	:	88030-7009
Country	:	US
Telephone Number	:	575-546-6746
Fax Number	:	575-546-6748

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

Provider Enumeration Date	:	12/28/2016
Last Update Date	:	12/28/2016

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Directions to “ CARLOS TREVINO ” Practice Location

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