MEDICARE: LAURA MANUELA TREVINO LOZANO

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	363LP0200X	Pediatric Nurse Practitioner	1090337	TX

General Provider Information

NPI Number	:	1790404390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA MANUELA TREVINO LOZANO

Provider Business Mailing Address
First Line	:	4502 MEDICAL DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-4402
Country	:	US
Telephone Number	:	210-358-4000
Fax Number	:	210-358-4775

Provider Business Practice Location Address
First Line	:	4502 MEDICAL DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-4402
Country	:	US
Telephone Number	:	210-358-4000
Fax Number	:	210-358-4775

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

Provider Enumeration Date	:	08/25/2022
Last Update Date	:	03/04/2026

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