1366629024 NPI number — CESAR D TRIVINO MD PA

Table of content: (NPI 1366629024)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366629024 NPI number — CESAR D TRIVINO MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CESAR D TRIVINO MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1366629024
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
304 LOMA LINDA LN STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BORGER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79007-8500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-275-9064
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 S MCGEE ST
Provider Second Line Business Practice Location Address:
ANESTHESIA SUITE
Provider Business Practice Location Address City Name:
BORGER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79007-4022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-275-9064
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
TRIVINO
Authorized Official First Name:
CESAR
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
806-275-9064

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  L5592 , 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)

  • Identifier: 0078KQ . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1629230-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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