MEDICARE: GABRIELLA 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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1700512530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELLA TREVINO

Provider Business Mailing Address
First Line	:	1600 WINDMILL RD
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88012-7462
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 WINDMILL RD
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88012-7462
Country	:	US
Telephone Number	:	575-571-9803
Fax Number	:

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

Provider Enumeration Date	:	07/25/2022
Last Update Date	:	07/25/2022

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Directions to “ GABRIELLA TREVINO ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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