MEDICARE: DR. MANUEL TREVINO DE LOS SANTOS M.D.

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	207VG0400X	Gynecology Physician	17206	NC

General Provider Information

NPI Number	:	1891774816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANUEL TREVINO DE LOS SANTOS M.D.

Provider Business Mailing Address
First Line	:	8318 ANCIENT OAKS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78255-3504
Country	:	US
Telephone Number	:	210-698-2172
Fax Number	:	210-698-3778

Provider Business Practice Location Address
First Line	:	8318 ANCIENT OAKS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78255-3504
Country	:	US
Telephone Number	:	210-698-2172
Fax Number	:	210-698-3778

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

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	07/08/2007

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