1215519731 NPI number — DR. DORA ELIA TREVINO DNP, APRN, FNP-BC

Table of content: DR. DORA ELIA TREVINO DNP, APRN, FNP-BC (NPI 1215519731)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215519731 NPI number — DR. DORA ELIA TREVINO DNP, APRN, FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TREVINO
Provider First Name:
DORA
Provider Middle Name:
ELIA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DNP, APRN, FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215519731
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/05/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 CONCORD PLAZA DR STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78216-6991
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-804-5416
Provider Business Mailing Address Fax Number:
210-678-4142

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2829 BABCOCK RD STE 700
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-6015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-396-5315
Provider Business Practice Location Address Fax Number:
210-396-5314
Provider Enumeration Date:
04/23/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  1033667 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)