1760411029 NPI number — MIGUEL E TREVINO MD PA

Table of content: MIGUEL E TREVINO MD PA (NPI 1760411029)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760411029 NPI number — MIGUEL E TREVINO MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TREVINO
Provider First Name:
MIGUEL
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD PA
Provider Gender Code:
M

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:
1760411029
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1573 S FORT HARRISON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEARWATER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33756-2004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-584-8777
Provider Business Mailing Address Fax Number:
727-584-8772

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1573 S. FT. HARRISON AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEARWATER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-584-8777
Provider Business Practice Location Address Fax Number:
727-584-8772
Provider Enumeration Date:
06/30/2006

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: 207R00000X , with the licence number:  ME0048086 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 005274100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com